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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 />2� I� I��� �� �� r�� � <br />PROJECT ADDRESS <br />1�1�;1�� L.o e� ��I� �.o�,h��.� Ev���T1; l�� �'aol <br />Property Owne Mail Address <br />���e <br />Tenant Name (If this is for a commercial business) <br />t�t� �e Ex-J t�?-P�V <br />Contractor Mail Address <br />IV � <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 />City <br />❑ Install Backwater Valve (outside the building) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />REVISED 11/19/2014 <br />C ity <br />State/Zip <br />State/Zip <br />Phone <br />City of Everett Business License Number (required) <br />FEE <br />.��o�� <br />PERMIT# <br />U C 5 d�- v��� <br />