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UTILITY PERMIT APPLICAiION <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 />�.� � � C� 1��-���,� �, ���.�--�- � �� � �-� I <br />PROJECT ADDRESS �-a,5 --�5 �— C(C�� <br />S � ��'C, � �(� C7 � � � `� �'�j ^ l�-�'-� lJl� � , � �Sc�� <br />Property Owner Mail Address City State/Zip Phone <br />Tenant Name (If this is for a commercial business) <br />�dC�- �-�so�sl <br />� � �`., ��.�`�� ��52.� � �-F�s�"�� 5��-H-�. c,t�� �i 's�o� <br />ContraCtor Mail Address City State/Zip Phone <br />� �� I �� <br />WA State Cont�tor 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 />re <br />REVISED 11/19/2014 <br />b�� L�g <br />City of Everett Business License Number (required) <br />��--- �5-- �.D 1 <br />Date <br />FEE <br />� <br />O� <br />PERMIT# <br />U���2� b5 <br />