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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 />1� t`7 i�i�.� l, la�� �j �` � <br />PROJECT ADDRESS <br />N�I : s� <br />Property Owner <br />; � y�z ����►���,�at1�= �v'�r��� �,` <br />� <br />Mail Address City Sta <br />Tenant Name (If this is for a commercial business) <br />� <br />., ,o� �i� , <br />Contractor 1VFdl Address City <br />�3�'�'c��,cti Rs��c��S' <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 />ature <br />REVISED i f/19/2014 <br />12�1�"-- l �� <br />Phone <br />�� <br />State/Zip Phone <br />C7L(3 `�'�/ j <br />City of Everett Business License Number (required) <br />FEE <br />�D � <br />PERMIT# <br />U � ��a-� � � <br />