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UT'1LITY PERtlIIIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257=8810 - FAX 425-257-8857 — www.evereitwa.org <br />� <br />�``� � �� ��C�,t �ti 1,� �-U� <br />PROJECT ADDRESS <br />���� <br />Property Owner <br />Mail Address <br />���1. ���— <br />Tenant Name (If this is for a commercial 6usiness) <br />CStc�� <br />� ��.��` �i-�� � �� " =� ���� <br />City State/Zip Phone <br />, � � - (� �� t, �.� � i�t � !�, � i� i� -,�`'-- !, { �� �n' �� �:� � � � 4t � ��'-' � �� � �� <br />Contractor Mail Address City State/Zip Phone <br />�� �`''�- �;�,,�.. ��i �� �, �a �- <br />WA State Contractor License Number (required) <br />Vllork to be done: <br />❑ Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer — New Installation <br />�°` <br />��7`� Install Backwater Valve (outside the building) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />� <br />� <br />REVISED 11/19/2014 <br />�—. , , ., <br />� � � `� � _. <br />City of Everett Business License Number (required) <br />FEE <br />���,�� <br />PERMIT# <br />U r �,��—��c� <br />