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UTILITY PERMIT APPLnCATION <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 Mail Address City State/Zip Phone <br />Tenant Name (If this is for a commercial business) <br />Mad Address City <br />WA Slate Co tractor License Number (required) <br />Work to be done: <br />❑ Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer — New Installation <br />istall Backwater Valve (outside the building) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />State/Zip Phone <br />e25-7 ( S"(r-> <br />City of Everett Business License Number (required) <br />FEE 'I' <br />k:6•fx� <br />l� �[Cj�q- <br />MIT4 <br />REVISED <br />11/19,2014 <br />