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UTILITY PERMIT APPLICATION <br />CITY OF EVERE TT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — wvnv.everettwa.org <br />2CY) Iglcn <br />PROJECT ADDRESS <br />Property Owner <br />Mail Address <br />Tenant Name (If this is for a commercial business) <br />v <br />Contractor Mai! Address City <br />�fGGGPG QG�G% <br />%NA State Contractor License Number (required) <br />Work to be done: <br />❑ Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer — New Installation <br />Install Backwater Valve (outside the building) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />:ry State/Zip <br />v'ii <br />State/Zip <br />Phone <br />Phone <br />aS3ris.f <br />City of Everett Business License Number (required) <br />FEE <br />�30 60 <br />PERMIT; <br />U �5n5- DidI <br />REVISED 1111912014 <br />