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e <br />UTILITY I�EI'�MIT 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 />� �,Y ��JL C�v���fi� W � �l��U � <br />� <br />PROJECT ADDRESS <br />� ��� �-��► �, i 5 � � �:T,�� A��� � U� �-��-t� �.� G1 ��' � �7� ��o T <br />Property Owner Mail Address City State/Zip Phone <br />Tenant Name (If this is for a com e��ial.business) <br />��t G�5 k�5 �' <br />�>�' �'�n �''l�� ��- � � � +�'i�j ti1�.�� <br />� <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 />� <br />City State/Zip `Phone <br />� � <br />_ � �� C� � X� <br />City of Everett Business License Number (required) <br />❑ Install Backwater Valve (outside the building) <br />❑ Cap off Sewer <br />❑ Instali Water Meter <br />� <br />� <br />�;� - <br />Signature <br />�/ <br />REVISED if/19/2014 <br />�/G j / l 5 <br />D <br />FEE <br />.��> C'�� <br />� <br />PERMIT# <br />� (� o�� -- ��z I <br />7y <br />