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. <br />' UTILITY PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />_� 'i ��' ;�V �c ��ta2 ��(S C�'U(1L�� ��2� � <br />PROJECT ADDRESS <br />�'�-TYt-� LdC r�✓/� C 6C t 9 @ � �t � ! `7 � 2-�' °ri'iC �2�-�-12� <br />Property Owner Mail Address <br />Tenant Name (If this is for a commercial business) <br />City <br />f��e<,.�G ar� ►� <br />34 � <br />�,-� f��3 G � � 7��' <br />State/Zip Phone <br />' S'�2�r 2�cP- �c� —� �2� <br />���C,n� PL ��s� a,.�.. ' �v �3c�x �� � S�.,o, �..�N � <br />Contractor Mail Address City State/Zip Phone <br />�, f�2D T PL-�� 3 r-'�- <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 />I�° Install Backwater Valve (outside the building) <br />.y <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />ature <br />REV/SED 11/19/2014 <br />'�—v-2ol� <br />Date <br />�5333� <br />City of Everett Business License Number (required) <br />FEE <br />�/� U� <br />l/ � <br />PERMIT# <br />U ( CooZ�� <br />