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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.everetlwa.org <br />PROJECT ADDRESS <br />Property Owner Fatal Address City State/Zp 2-72-4n4TO14/ <br />Tenant Name (If this is for a commercial business) <br />Contractor Nla,lAddress City State/Zp Phone <br />6 p& 1*4--11PA <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 />U't<S'ialI Backwater Valve (outside the building) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />12 <br />City of Everett Business License Number (required) <br />FEE <br />m'00 <br />PERMIT# <br />Date U l+0 O' I - Oq <br />REVISED 1 i M14 <br />