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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 /> 7/�_5 q q <br /> PROJECT ADDRESS <br /> DN� 0eV&-HTL1 J C 7 0 q qA 5-r--5 E EVE WA- q� K <br /> Property Owner Ms Address City State/Zip Phone <br /> Tenant Name (If this is for a commercial business) <br /> D4ti,',i-tJ ri:�-p PL-m&,+ i��. 3� A we_ LQ- L-YAM. i t k gW37 <br /> Contractor Mail Address City State/Zip Phone <br /> DAyN-Tp" Lj Ll 4Q e0q:24I <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 /> i �0 oo <br /> •� ��(� PERMIT# <br /> Si ature Date 1 ' 14 r 5 t <br /> REVISED 11/19/2014 V I <br />