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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 /> PROJECT ADDRESS <br /> 0jv) nC lieQJ5 ;uJ CQW-4 � a) W61-Y <br /> Pr ertyOwner Mail Address y7v�C ele Phone <br /> l., � , J Ce <br /> Tenant Name (If this is for a commercial business) <br /> t'D P Lj-,C- <br /> Contractor Mail Address City State/Zip Phone <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 /> 000 <br /> _ d <br /> PERMIT# <br /> Signature Date 1 ' J 00 <br /> REVISED 11/19/2014 Unl <br />