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UTIL.ITY PERM11' �PPLICATION <br />CI1`Y OIF E0lEREiT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257=8810 - FAX 425-257-8857 — www.everettwa.org <br />� �Z� <br />�� �-� <br />� �� <br />PROJECT ADDRESS <br />< < � `7�'�G�-� �� <br />�,-�q.��'.�iYis., ��-����8 � 1�3��,11`��7'� ��, ��e 5 Lc�C� . `����I,f� <br />Pfoperty Ownei Mail Address City State/Zip Phone <br />�t� �,i + J <br />Tenant Name (If this is for a commercial business) <br />-"� � "�. A' �r"+ a ,—'^" � � � `t 7 � � <br />� � �`' �,� �e"�« � C��'� �'�� F.>"��t�-"` ���-� �� �� <br />!=�� � . � _ �� �--` � , �` �; •c :al � �,'1 �.� �, � � w • ,�, -�x: C� .� � <br />Contracto� Mail Address City State/Zip Phone <br />�; ���,?'s=...' �, t ��_��� �, ��'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 />� <br />�`�Instali Backwater Valv� (outside the building) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />�------� <br />Date <br />REVfSED il/19/2014 <br />� � <br />�'`l � � `j °� �� <br />City of Everett Business License iVumber (required) <br />FEE <br />� <br />PERMIT# <br />u ���2-D�I <br />