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3 <br />UTIL�T� PERMIT APPLICATt�N <br />�1TY �F Ei/ERETT PERMIT SER1/ICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257=8810 - FAX 425-257-8857 — www.everettwa.org <br />� �.:�I �: � > C ' �" � �;��_�. <br />`l cL. _ � <br />PROJECT ADDRESS <br />`����� ������� �,� �� <br />� �� ��� <br />Property Owner Maii Address <br />i(� � ' � <br />Tenant Name (If this is for a commercial business) <br />City <br />�L�'� ���; (�;��� � <br />State/Zip <br />( u,��� <br />����'�'� -�-� �" <br />Phone <br />�a�-a� ?�;��,, ��.�;�ta�� ��, �1���-'' I t�� � ���'°°��;�� C`,.,�. ���— ��wr ; �'� <br />� . �� <br />ContraCtor Maii Address City SfateiZip Phone <br />%� �`��'�. �;�: t �� ���.��, � � 1_- <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 />F3` Install Backwater Valve toutside 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 />� �U,°i <br />PERMIT# <br />� 11�0�-OD2 <br />