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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 /> 78 Z`3- Yv <br /> PROJECT ADDRESS <br /> 4(,o I yj,� �-e � t( I &j 6ve ram& /j 0 <br /> Pror6y Owner Mail Address City State/Zi Phone <br /> Tenant Name(If this is for a commercial business) <br /> LLQ <br /> Contractor Mail Address City State/Zip Phone <br /> 41113 13 <br /> WA State Contractor License Number(required) City of Everett Business License Number(required) <br /> Work to be done: <br /> ❑ Side Sewer Repair <br /> ❑ Side Sewer Alteration <br /> ❑ Side Sewer— New Installation <br /> ❑ Install Backwater Valve (outside the building) <br /> Cap off Sewer <br /> ❑ Install Water Meter <br /> FEE <br /> 00 <br /> L <br /> r PERMIT# <br /> Signature Date U ) 50&- 00(0 <br /> REVISED 11/19/2014 <br />