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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 /> 37D - Ytk€ lc <,//c1- <br /> PROJECT ADDRESS <br /> 67 62 ru__Vy (9.9e14 ptiD re yf4.---cts ‘05-31(ec, <br /> Property Owner Mail Actress City State/Zip g175 <br /> Tenant Name(If this is for a commercial business) <br /> •5236 a tact ?LC aS 9131 <br /> Contractor Mail Address City State/Zip Phone <br /> HP/ A/1, -3f /0015 m <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 /> ‘1')%14. S--f PERMIT# <br /> Signa re Date <br /> REVISED 11/19/2014 <br />