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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 /> 24 5 A\ � <br /> PROJECT ADDRESS 1 <br /> Property Owner Mail Address City State/Zip Phone <br /> Tenant Name (If this is for a commercial business) <br /> (Lj Z-0 <br /> L r110 JR, ig�UZ-7��l UJ q. 'qf-L-qjg5gt <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 /> Ea Install Backwater Valve (outside the building) <br /> ❑ Cap off Sewer <br /> ❑ Install Water Meter FEE <br /> 0 <br /> PERMIT# <br /> Sig at e/ Date U <br /> REVISED 11/1912014 <br />