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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 /> 823_ d&v Ptvt <br /> PROJECT ADDRESS <br /> 1 -v' ( f 22 12,vaii' -Ev ...i 9'-Z 1 C 00 Se <br /> Property Owner Mail Address City State/Zip Phone <br /> Tenant Name(If this is for a commercial business) <br /> t-1�4k e . w+>4 e{t- '= --o/? 3 <br /> Contractor Mail Addr s 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 Valveoutside the building) <br /> J) <br /> ❑ Cap off Sewer <br /> ❑ Install Water Meter <br /> FEE c0 <br /> )6.()"t <br /> 3a-/ S PERMIT# <br /> ''gnature Date <br /> u15-06- 1-Lo <br /> REVISED 11/19/2014 <br />