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UTILITY PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, 01A 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa org <br />1- 7 ( ? 0 S( <br />PROJECT ADDRESS <br />bo V <br />Property Owner Mail Address Gty Stale/Zip Phone <br />Tenant Name (If this is for a commercial business) <br />1-s ��Llrh� i <br />Contractor 1 Mail Address <br />(7A111 tea P 1917 M S <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 />City <br />9 Install Backwater Valve (outside the building) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />State/DD <br />Phone <br />O`i�'7o3 <br />City of Everett Business License Number (required) <br />FEE //-�� <br />v' crzf <br />PERMIT# <br />U611-IOA <br />REVISED I U1912014 <br />