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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 />G �l ' o �' <br />PROJECT ADDRESS <br />fAl� Y` � 1ti- �. Y` V�, �c L� c� � Rr 0 <br />Property Owner Mail Address City <br />Tenant Name (If this is for a commercial business) <br />� �� ��5�'�� �'�O • i � � S� �S � @v_,,�� r <br />Contractor Mail Address City <br />c� .� I <br />WA tate �ntractor License Nu ber (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 />� �,P�C1 ti. c� � —/D � �� <br />nature <br />RC-VISED 11/19/2014 <br />State/Zip <br />State/Zip <br />Phone <br />�� <br />Phone <br />� ���o `7�L3 <br />City of Everett Business License Number (required) <br />FEE <br />°� '� �l� <br />,l�� ✓ <br />✓ � <br />PERMIT# <br />� I �� ��� - �,� �C <br />