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r <br /> 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 /> iritO2 ()Dees Auei <br /> PROJECT ADDRESS <br /> 1'64)1 f3erit.tu ` 02 C 65 te (ute <br /> L-/ CO A RVO <br /> ro ertY Owner Mail Address City State/Zip <br /> Phone <br /> Tenant Name(If this is for a commercial business) <br /> r 070f <br /> Contractor Mail Address City State/Zip Phone <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 <br /> FEE <br /> 00 <br /> (Q T Ac PERMIT# <br /> —Signature Da e U 15-069— 0 <br /> REVISED 11/19/2014 <br />