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• <br /> t* <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 /> /6 ( 2+ 44.9r <br /> PROJECT ADDRESS <br /> Eve r f - vs f 9532 .5v1 o R.fl Ro y4 WA 99357 5-6, 34-6-2•f28` <br /> Property Owner Mail Address City State/Zip Phone <br /> Tenant Name(If this is for a commercial business) <br /> Self same <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 (ou ide the building) a/fey pa v d over <br /> ❑ Cap off Sewer <br /> ❑ Install Water Meter <br /> FEE <br /> 3000 <br /> 1taiia / ib� F 'A- - g _l S PERMIT# <br /> Signature / Date U 150G - <br /> 5OG -o3g <br /> REVISED 11/19/2014 <br />