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UTILITY PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-3810 - FAX 425-257-8857 — NAvw.everettwa org <br />rvC iLe <br />Vie — <br />PROJECT ADDRESS <br />b-11 Hr-L !c . .3zr? rt.�lce� <br />Properly Owner <br />Mail Address <br />Tenant Name (If this is for a commercial business) <br />:ontractor Kait Aadress cny <br />�afl,12 l 9/7M5 <br />WA State C ntraclor License Number (required) <br />Work to be done: <br />❑ Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer — New Installation <br />2 Install Backwater Valve (outside the building) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />� 4��- 4x 1�-6&1^ Signature Da e <br />c'ty <br />Stale/Z,p <br />c/z5 —3 7 <br />_d<y l l <br />Phone <br />PZo� yzs" - Zs y-3$Ile <br />Phone <br />OL/?`7 3 <br />City of Everett Business License Number (required) <br />FEE <br />PERMIT# 1 <br />U 1502- I ZO J <br />gn'sED 11/19%014 <br />