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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 /> `C) ` <br /> PROJECT ADDRESS <br /> J�Z 06&2 <br /> Property Owner Mail Address City State/Zip Phone <br /> ,rt cn,0 <br /> Tenant Name(If this is for a commercial business) <br /> _ (Li ZS) <br /> aJ rPn Ck' ;7—gLL -cls 5 q <br /> Contractor Mail Address City State/Zip Phone <br /> Iq P5 <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 /> Hdf Install Backwater Valve (outside the building) <br /> ❑ Cap off Sewer <br /> ❑ Install Water Meter FEE <br /> y — PERMIT# <br /> , Sig at e <br /> Date U O �� <br /> REVISED 11/1912014 <br />