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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 />�� �� � rt � <br />PROJECT ADDRESS <br />�����b��� <br />Property Owner <br />Mail Address <br />Tenant Name (If this is for a commercial business) <br />City <br />� <br />•�(��T <br />State/Zip <br />Phone <br />�-(ol �s�a�, �f b . P,o.�'63� �.��� i,,�c�, �q�� � as� ���/ <br />Contractor Mail Address City State/Zip Phone <br />%� L wts� roo�" W� � <br />WA State Contractor License Number (required) <br />Work to be done: <br />�Side Sewer Repair <br />❑ Side Sewer Alteration <br />� <br />❑ Side Sewer — New Installation <br />❑ Install Backwater Valve (outside the building) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />�� <br />�' ' <br />Signatu <br />REVISED 11/19/2014 <br />� <br />Date <br />� t��ac��l� <br />City of Everett Business License Number (required) <br />FEE <br />r ;� <br />�� ���'�, �_�' ` <br />�,, <br />PERMIT# <br />U��'JJ" �:;J. <br />/� <br />