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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 /> ali(Q //irf r`itee <br /> PROJECT ADDRESS <br /> Property Owner Mail Address City State/Zip Phone <br /> 1err r /lG 6‘.4 <br /> Tenant Name(If this is for a commercial business) <br /> ee-VS <br /> Contractor Mail Address City State/Zip Phone <br /> d,i/9b fl-Tf7 4. . O'77oJ <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 /> JInstall Backwater Valve (outside the building) <br /> ❑ Cap off Sewer <br /> ❑ Install Water Meter <br /> FEE <br /> JD, av— <br /> PERMIT# <br /> Signature Date I' I�V j <br /> U <br /> REVISED 11/19/2014 <br />