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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 />Property Owner <br />Mail Address <br />Tenant Name (If this is for a commercial business) <br />Contractor Mad Aaaress �••� <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 />E1 Install Backwater Valve outside the building) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />City <br />state zip <br />(z53) <br />ZZ3-RGL 5 <br />Phone <br />n!�3 5�63- <br />City of Everett Business License Number (required) <br />- / 5 - zo15 <br />FEE �OOO <br />PERMIT# <br />U 1 SDI- o6Z <br />REVISED i 11=014 <br />