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UT�L.ITY PERMII" APPLBGAiION <br />CITI( OF EVERETT PEI�MIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257=8810 - FAX 425-257-8857 — www.everettwa.org <br />� � �� a.�l � i � L�� /� <br />PROJECT ADDRESS �"��� <br />�.A � � ►'�I,c�,�'�, ��2- (� � 1 ���.+l�.1 ��� `i �.�.c.� � �, l�..,U�-�' /�j,��l'� , �� — ��� <br />Property OWner Maii Address City State/Zip Phone <br />Tenant Name (If this is for a commercial business) <br />�`�- � �� ��. � � , � �:; F�,C ; �� � �?, � <br />Contractor Mail Address <br />�� �'`�'°� �-� 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 />City <br />.s �'-1 �`✓ ) <br />4�' �`� F;�,;�-1 ���-- C�C� � � <br />StatelZip Phone <br />: � �� �� �' �� _ <br />City of Everett Business License Number (required) <br />�` Install Backwater Valve (outside the building} � � � ����� � �� � � ��� <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />.._._.._., <br />� <br />FEE <br />'C'1 �� � �J <br />PERMIT# <br />U � ���.�� � <br />REVISED 11/19/2014 "' <br />