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. <br />UTILITY PERMIY APPLICATiON <br />CITY OF EVERETT �ERM11' SEl�VICES <br />320Q CEDAR STREET, EVERETT, WA 98201 <br />425-257=8810 - FAX 425-257-8857 — www.everettwa.org <br />�, �l,f� .� �-l�� S l <br />PROJECT ADDRESS <br />� <br />Property Owner <br />21,1�,���--�7�, <br />Mail Address City <br />Tenant Name (If this is for a commercial business} <br />� r 3 �l� ^- �'zt��� <br />State/Zip Phone <br />�a, �.,. � �. � �� �, �,l:c� �!'�; �`� �F � ��=-�� 9;t �ti `i � : �� ��� � :��t_a— �'t" �� �' `f <br />o-� <br />Contractor Mail Address City State/Zip Phone <br />=� � ��A'�:;..�'`� � `��;�a ��`��` �i, �'�'� � <br />WA State Contractor License Number (required) <br />Work to be done: <br />❑ Side Sewer Repair <br />❑ Side Sewer Alteratian <br />❑ Side Sewer — New Installation <br />c a �� -� �':� `��� <br />City of EverettBusiness License Number (required) <br />�`�tnstall Backwater Valve (outside the building) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />� <br />� <br />REV/SED l i/19/2014 <br />FEE <br />� �� <br />�� <br />PERMIT# <br />U ��%Q����, <br />