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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 />- <br />Property Owner Mail Address city State/Zip Phone <br />Tenant Name (If this is for a commercial business) <br />Contractor Mail Address citr State/Zip Phone <br />C-'q1;1'PhP-+T 9/7 1-7s <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 />K Install Backwater Valve (outside the building) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />Signature <br />Oi 770-,? <br />City of Everett Business License Number (required) <br />FEE - — <br />O / PERMIT# - - <br />U65D�-v <br />REVISED 11/19r701e <br />