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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 />_zQo L 09A-y�D <br />PROJECT ADDRESS <br />V i <br />Propei y Owner <br />Mail Address <br />Tenant Name (If this is for a commercial business) <br />Contractor Mail Address City <br />A `,)E <br />WA State Contractor License Number (required) <br />Work to be done., <br />❑ Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer — New Installation <br />9 Install Backwater Valve outside the building) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />City <br />State/Zip <br />o�) <br />Phone <br />(4Z5) <br />17—ti `i — 9 �t 5 <br />Slaletzip Phone <br />n53 °-4C13 <br />City of Everett Business License Number (required) <br />FEE <br />3000 <br />is PERMIT# r q <br />U I5w-dr`t I <br />eEVISFD 11/19,7014 <br />