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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 /> z 7l su‘) <br /> PROJECT ADDRESS <br /> 3 ,/t3 POQictr5 S /_ <br /> Property Owner Mail Address City State/Zip Phone <br /> Tenant Name (If this is for a commercial business) <br /> } <br /> &,/o - 1E/ /0 lv SS 17.44w'0,4 4,4,41 7 .11 at_ vfl- F8/6 4/2s 773-2Z 7 <br /> Contractor Mail Address City State/Zip Phone <br /> kZv{-o ia_s& /22$L 03 71 2 <br /> WA State Contractor License Number(required) City of Everett Business License Number(required) <br /> Work to be done: <br /> Side Sewer Repair <br /> ❑ Side Sewer Alteration <br /> ❑ Side Sewer— New Installation <br /> 0 Install Backwater Valve (outside the building) 6 <br /> ❑ Cap off Sewer <br /> ❑ Install Water Meter <br /> FEE e� <br /> VIA® !',f;e. <br /> L%✓ /C PERMIT# <br /> Signature ate U I ji0' �tU <br /> REVISED 11/19/2014 <br />