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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 /> 3 <br /> 5 :2 3 <br /> PROJECT ADDRESS <br /> Property Owner Mail Address City State2ip Phone <br /> Tenant Name(If this is for a commercial business) <br /> PIL4/► 7 Sj S L�I sr sf-. S� SP-r��i � s� 1-✓ r'l�Z�i�s L/?S 7W& X6 <br /> Contractor Mail Address <br /> City State0p Phone <br /> (h 0 d?.," t�' 3 3-0 0S -?::> (� 3 S <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 2 <br /> S PERMIT# <br /> Signature Date <br /> U I fob2-Do <br /> REVISED 11/19/2014 <br />