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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 />'-1 q 2 l Cs-r2� � 0� <br />PROJECT ADDRESS <br />Property Owner Mad Address <br />Tenant Name (If this ,s for a commercial business) <br />Moe,. PINM7 1%5-1J—15,'JS SG �^A-:D- <br />Contractor Mail Address City <br />WA State Ccntractor License Number (required) <br />Work to be done: <br />❑ Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer - New Instaliatior, <br />0 Install Backwater Valve (outside the building) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />q,Zr .2 3W— _% <br />City Statellip Phone. <br />4P7-1,0 L4Zt 7(70� 1G <br />State/Zip Phone <br />yi�3(�3!;-- <br />City of Everett Business License Number (required) <br />FEE <br />4- -So POn <br />PERMITl# <br />U <br />REVISED 11/19/2014 <br />