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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 />- � � �� <br />�/�3 � vc,�% � � 2 <br />PROJECT ADDRESS <br />�i � j� �r s � ,�5�;�-e5 <br />Property Owner Mail Address <br />Tenant Name (If this is for a commercial business) <br />City <br />State/Zip <br />Phone <br />��- <br />cdx; -,�;�,-- /� � s .� r�� �u .���I �-��,,� �1 � �tirt- f'�: �; �, �Zs � �7 3 - zzs <br />Contractor Mail Address City State/Zip Phone <br />'� �i-� �zSL � 22 8 ,�. <br />WA State Contractor License Number (required) <br />Work to be done: <br />/ <br />, � Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer - New Instaliation <br />❑ Install Backwater Valve (outside the building) � <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />;_ �. <br />Sianature <br />REVISED 11/19/2014 <br />437��z�d <br />City of Everett Business License Number (required) <br />�/z_�-/i� <br />ate <br />FEE <br />�� D� <br />PERMIT# <br />u����o53 <br />