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y 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 /> tSL3 <br /> PROJECT ADDRESS <br /> � - u_ 3 -logo <br /> Property Owner Mail Address City State/Zip Phone <br /> Tenant Name(If this is for a commercial business) <br /> 0.10 <br /> Contractor Mail Address City State/Zip Phon <br /> cs os �r(AD 0/& 7 <br /> WA State Contractor License Number(required) City of Everett Business License Number(required) <br /> Work to be done: <br /> ❑ Side Sewer Repair <br /> O Side Sewer Alteration <br /> ❑ Side Sewer- New Installation <br /> [°f Install Backwater Valve (outside the building) <br /> ❑ Cap off Sewer <br /> ❑ Install Water Meter <br /> FEE <br /> 417 Of) <br /> ri Pit41 3 3 PERMIT# <br /> Signature Data <br /> REVISED 11/19/201 <br />