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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 /> � -I � � (T'�-v✓� �� �� <br /> PROJECT ADDRESS <br /> Mc,,t�j�,n''�-. <br /> P�opertypwne� MailAddress City State2ip - Phone <br /> Tenant Name(If this is for a commercial business) <br /> 1'� oe:� (��u,Mh��� r�s� s y�`-� s�-. v= ��G�u.��sL, wl� ��z�� yas��fr��o <br /> Contraclor UMail Address Cily State2ip Phone <br /> rno•�'� P��:- SSFf35v 053635 <br /> WA Stato Contractor License Num6er(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 /> C7 Cap off Sewer <br /> ❑ Install Water Meter <br /> FEE <br /> �{ � 'j0, �� <br /> _�� �` `� 6 �' �O � I .S� PERMIT# - <br /> Signoturc .. �Oate � , 1 Il^ �r � l��' <br /> U '"� l0 <br /> � REVISE011/19/2014 <br />