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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 />y T �► <br />Property Owner <br />Mail Address <br />Tenant' flame (If this is for a commercial business) <br />Contractor Mail Address City <br />A1.610_155e �S <br />WA Slate Contractor Licerf5e Number (required) <br />Work to be done: <br />❑ Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer — New Installation <br />6ff Install Backwater Valve (outside the building) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />City <br />Phone <br />Phone <br />�?a <br />City of Everett Business License Number (required) <br />-(:?d-?dlS- <br />PERMIT# <br />U t5a3-I I2 <br />REVISED I MaW 1J <br />