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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 />� �� !S l�'t�� St <br />PROJECT ADDRESS <br />Property Owner <br />Mail Address <br />Tenant Name (If this is for a commercial business) <br />City <br />State/Zip <br />Phone <br />�� <br />G<:�rc; -,�r,,�,� lv � 5 S T��,, �u �e:vcl T��w� Il � �ti/t— fff� �; �', �Zs � �7 � • �zs <br />Contractor Mail Address City State/Zip Phone <br />� i-� � rZSL � 22 8,�. <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 buiiding) � <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />re <br />REVISED 11/79/2014 <br />9/� <br />037�z�d <br />City of Everett Business License Number (required) <br />FEE <br />�D��O <br />PERMIT# <br />U ��..e4� - (� <br />