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. <br />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 />s��� �S c.C->C`�%l-��'�, C;� l�� <br />PROJECT ADDRESS <br />� � ) �� <br />�T� �'Y�'l��S �C�C`-}-����r='c� �'����5 <<;�m►'1�^�c�"�� "7 ���-- �,U�'-��-� �~�� `'l � `"-�� -� - <br />Property Owner Mail Address City State/Zip Phone <br />Tenant Name (If this is for a commercial business) <br />r�t,��,.\I��' Il'f�O U '� L/`� C't � � 4 <br />7�lv �C�t�' �U(CSS �i;xl,U.��t 1'✓lr�'r1�,l�,C�n<'1 � �� .�- ,�.( id��cv <br />ContraCtor Mail Address City State/Zip Phone <br />���U(�sc� ;22 d3� <br />WA State Contractor License Number (required) <br />Work to be done: <br />ide Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer — New Installation <br />❑ Install Backwater Valve (outside the building) <br />❑ Cap off Sewer <br />❑ Instali Water Meter <br />gnature <br />REVISED 11/19/2014 <br />.�J���-� 2� <br />City of Everett Business License Number (required) <br />FEE <br />� ��r� <br />PERMIT# <br />U�JQ�—IC��J <br />