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UTILITY PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />ISz-? ?�"�5� S� <br />PROJECT ADDRESS <br />e r .� <br />Property Owner <br />52-1 <br />Mail Address <br />� i so6�o�5 <br />,nd St S 1' CV g ley 4f W l go2o 5 <br />Tenant Name (if this is for a commercial business) <br />S 411riwes4 P1jrA ,',,5 41o) Dr.f rrQ/i14k& <br />Contractor Mail A dress City <br />WState Contractor License Number (required) <br />Work to be done: <br />J& Side Sewer Repair <br />, <br />❑ Side Sewer Alteration <br />❑ Side Sewer — New Installation <br />❑ Install Backwater Valve (outside the building) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />m.srn i rnaaor4 <br />City <br />6 '15- 15 <br />Slate/Zip <br />State/Zip <br />Phone <br />r•none <br />City of Everett Business License Number (required) <br />3000 <br />PERMIT# <br />U )50(�• c*5 <br />