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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.everethva.org <br />PROJECT ADDRESS <br />>r IZP A b o'&A `l <br />Property Owner Mail Address <br />Tenant Name (If this is for a commercial business) <br />Contractor Mad Address city <br />c c, K�- <br />WA Stale Contractor License Number (required) <br />Work to be done: <br />❑ Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer — New Installation <br />L7 Install Backwater Valve (outside the building) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />City <br />(pC9 <br />901 <br />state2ip <br />—0�7 <br />Phone <br />2z (415) <br />t iJ Zr-r'-L.... 9 C(7 �1 <br />stata2ip Phone <br />City of Everett Business License Number (required) <br />FEE <br />30 <br />PERMIT# <br />We U 150 3— 0 Z <br />REVISED 17151014 <br />