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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 />PROJECT ADDRESS <br />Less A (lam, <br />Property Owner <br />3t- t-7 G„ <br />Mail Address <br />Tenant Name (If this is for a commercial business) <br />Contractor u Mad Address City <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 />`4' Install Backwater Valve (outside the building) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />C12Cy7Jv.)oG <br />City State/zID Phone <br />C L_,& 9�-S 7G0 Ft3�a <br />State/Zip Phone <br />bS-SL-3S� <br />City of Everett Business License Number (required) <br />FEE <br />PERh1IT# <br />U 15o3-I �5 <br />REVISED 1111917014 <br />