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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 />%3 �_Ll -� s s �� s� Sl: <br />PROJECT ADDRESS <br />�� �5�� �� S�-<��� 23z,�1 �s����� ��� ����-�� �,�� )�� <br />Property Owner Mail Address City State/Zip <br />Tenant Name (If this is for a commercial business) <br />, � , <br />��;� �, < < -�,- :� �� �.; �,, .r__ �,�, �� 1 � �,, �, �„� � � <br />Contractor Maii Address Ci� <br />i U�S«��1D�� <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 />❑ Install Backwater Valve (outside the building) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />�� -- � -- ` <br />Date <br />REVlSED 11/19/2014 <br />�y�; z'`� �� S�2 �s-i <br />Phone <br />`1 �,; -5�:, i-�S <br />State/Zip Phone <br />Cj 5�3��i � <br />City of Everett Business License Number (required) <br />FEE <br />� .� `� <br />PERMIT# , <br />u ���a� -o�I� <br />