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1 <br />UI1"ILITY PERMIT APPLICATION <br />CtT1( OF E\/ERETT PERMIi SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257=8810 - FAX 425-257-8857 — www.everettwa.org <br />� � <br />�� �� �.�� � <br />PROJECT ADDRESS <br />,. , c _ .. . 1 <br />L�P�i � <br />Property <br />Mail Address <br />�rl tJ 1�. <br />Tenant Name (If this is for a commercial business) <br />, �'� 1�1� �c�' <br />8;� � � �� � C. �._-v� �'.� � a� �, �? � 1 � � � <br />Contractor Mail Address City <br />%� �°`�'�.. �; i �� �� � i� �—. <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 />f <br />� Install Backwater Valve (outside the building) , <br />❑ Cap off Sewer ' <br />❑ Install Water Meter <br />� <br />REVISED ii/19/2014 <br />�- G <br />Date <br />City <br />C� ��� <br />�Iz. -����7 <br />State/Zip Phone <br />��.� � J �`�,"�t ``�" �C� �' ft <br />StatelZip ' Phone <br />c�� � 4`� �`c� <br />City of Everett Business License Number (required) <br />.- c� <br />FEE <br />� <br />��a� <br />PERMIT# <br />U I �d�-� ��� <br />