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0 <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 />� l � � � �� l <br />PROJECT ADDRESS <br />� e <br />Property Owner <br />e</u� ��l, <br />Mail Address <br />Tenant Name (If this is for a commercial business) <br />U <br />Contractor <br />0 <br />� � <br />� ���� 1�.� i �,�1 �2 <br />Mail Address City <br />����� sP � �o� �u�? <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 />Sianature <br />REVISED 11/99/2014 <br />C ity <br />� <br />StatelZip <br />���� �� ac� <br />Phone <br />� r `7��i�� � � � `�% :�%� <br />State/Zip Phone <br />� � o a �9 �� <br />City of Everett Business License Number (required) <br />.� �---� -; <br />.� <br />FEE <br />�C��o <br />PERMIT# <br />U ( (� G� � - (? �s� � <br />