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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 />Pfe Deriv Owner Mail Address ".ty StalelZip Phone <br />Tenant Name (If this is for a commercial business) <br />// <br />Contractor <br />ress <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 />City <br />nstall Backwater Valve (outside the building) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />REVISED 11119P014 <br />t,r r q? j-- 11 b' f - d r? <br />StatelZ,p Phone <br />eq <br />J�J f <br />City of Everett Business License Number (required) <br />FEE <br />� 3o,oO <br />^� S/ PERMrr# <br />