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• � <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 />:-���-� <br />� ;%� U��Cs'� �rl� <br />PROJECT ADDRESS <br />11 �� c'_ �� � �act �� S �. � f ��' /�� <br />�roperty Owner Mail Address <br />Tenant Name (If this is for a commercial business) <br />� <br />C ity <br />State/Zip <br />L' <br />y1>"�y:�t ,77?�' <br />�°4, <br />; ,�.,� <br />Contractor Mail Address City State/Zip Phone <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 />' Signat e �_ .--� <br />RC-VISED 11/19/2014 <br />,--= <br />�';� �� _ � L, <br />� � <br />Phone <br />City of Everett Business License Number (required) <br />FEE <br />� <br />�� � <br />PERMIT# <br />U �� l%��- /�� �� <br />