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UTILITY PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERET , <br /> WA 425-257=8810 - FAX 425-257-8857 —www•everettwa.org <br /> } C, U �o <br /> PROJECT ADDRESS 309 <br /> ` u <br /> o 1A / ` State/Zip Phone <br /> City <br /> Property <br /> Owner Mail Address <br /> Tenant Narmn (If this is for a commercial business) <br /> ll r�,t ' ti <br /> C a, CJ Gtk.4IG1 �Q� �= v Phone <br /> Contractor _ Mail Address <br /> City State/Zip <br /> l� C� City of Everett Business License Number(required) <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 /> p Install Backwater Valve (outside the building) <br /> ❑ Cap off Sewer <br /> ❑ Install Water Meter FEE <br /> --_ <br /> PERMIT# <br /> Date i�o�-o2 <br /> Sig at e U <br /> REVISED 11/1912014 <br />