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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 /> � a7 � S- (.�. <br /> PROJECT ADDRESS <br /> lQ Ll sa l+c <br /> Propertowner Mail Address City State/Zip Phone <br /> Tenant Name (If this is for a commercial business) <br /> -06 ?gam Q739 ',11�/ <br /> Contractor Mail Address City State/Zip Phone <br /> rA <br /> WA State Contractor License Number(required) City of verett Business License Number(required) <br /> Work to be done: <br /> 112(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 /> PERMIT# <br /> Signature Date U 6 U b 1 t ��n <br /> REVISED 11/19/2014 <br />