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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 - wvwv.everetNva.org <br />29/fie S' - <br />PROJECT ADDRESS <br />M file/ <br />Property caner Mail Address City State/Zip Phone <br />Tenant Name (If (his is for a commercial business) <br />t/LS <br />/I�i/a P/an B �.g .S t/o7 �/d'� A✓�,✓�% /WiiT ,,.. . /j,QAzxi 357 /Ssl <br />Contractor Mail Address City State/Zip Phone <br />WA Stale Contractor License .'Dumber (required) <br />Work to be done: <br />❑ Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer - New Installation <br />�1 Install Backwater Valve (outside the building) <br />❑ Cap off Sewer <br />E-I Install Water Meter <br />% //Z <br />G -S' 3 t/SS <br />City of Everett Business License Number (required) <br />FEE <br />PERMIT# <br />REVISED 1111912014 <br />