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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 />� �I a � �� � r�l�C�cv� ��yr�' - cl � � o 3 <br />PROJECT ADDRESS <br />( C Vl. J d�, � <br />Property Owner <br />�Sc� � <br />Mail Address <br />Tenant Name (If this is for a commercial business) <br />��►�S-t��� sPl�. ��.� ��� ��,� <br />ContraCtor Mail Address City <br />�bl �tJSP/2� x�a <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 />ure <br />REVISED > 1/19/2014 <br />� <br />��w�• <br />� <br />City <br />�: <br />State/Zip <br />)�i , ao <br />StatelZip <br />�, <br />Phone <br />Phone <br />� �C2ac���l3 <br />City of Everett Business License Number (required) <br />FEE <br />�a_�c.� <br />PERMIT# <br />U ����-Dl� <br />