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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 /> 5 s <br /> CerflA QC041 <br /> , <br /> C, v-her- (5 -FT `4'' otilp5r <br /> PROJECT ADDRESS <br /> ��► L � LC-c. c ( 1564 (/6-v.e !- 8067 17-3-:--4Z-5111* <br /> Property Owner Mail Address City f State/Zip Phone <br /> Tenant Name(If this is for a commercial business) <br /> 9 <br /> 19q )'-C g(� -I r- 772 1 I/ /P /\ 4414/' q(8017- <br /> Contractor <br /> (o17-Contractor Mail Address - City State/Zip Phone <br /> PA J Cis3779 <br /> WA State Contractor License Number(required) City of Everett Business License Number(required) <br /> Work to be done: <br /> ❑ Side Sewer Repair <br /> ❑ Side Sewer Alteration <br /> ❑ Side Sewer- New Installation <br /> ❑ Install Backwater Valve (outside the building) <br /> ❑ Cap off Sewer <br /> Install Water Meter - z r r r yc2 7 0-7 j ( 1 <br /> J FEE <br /> 00 <br /> 11V$0 <br /> 74 (S PERMIT# <br /> Signature Date U t SQ ^01+4 <br /> REVISED 11/19/2014 <br />