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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 />��SD� G'C�-�/t-��Ea�v�� /��� <br />PROJECT ADDRESS <br />� J�lL9Ne't � J� f�"C lL 25U1 G'Lc 1/c��iY'�� :�G�c- t!/t%2� 7T j/�//� 6���� y25 -Z%'�%. ��(�� / <br />Property Owne� Mail Address City State/Zip Phone <br />Tenant Name (If this is for a commerciai business) <br />vG'i/�'✓✓G-� <br />ContraCtor Mail Address <br />WA State Contractor License Number (required) <br />Work to be done: <br />❑ Side Sewer Repair <br />� Side Sewer Alteration <br />❑ Side Sewer — New Installation <br />City <br />❑ Install Backwater Valve (outside the building) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />ure <br />REVISED 11/19/2014 <br />-�% 1�'i.`� <br />State/Zip <br />Phone <br />City of Everett Business License Number (required) <br />FEE <br />�V D� <br />PERMIT# <br />� l�j�� 'a1� <br />