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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 />l l� �-7 s� S° � ��l�� �g�d3 <br />PROJECT ADDRESS <br />�I l%1'12 �C t:c V�� �- <br />Property Owner <br />Mail Address <br />Tenant Name (If this is for a commercial business) <br />�c� � ►� S� ��-�, � l�� ��4 �� �e 3.�� <br />ContrBCtor Mail Address City <br />� J <br />WA State Contractor Lice se 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 />Signature Date <br />REVlSED il/19/2014 <br />C ity <br />State/Zip <br />� <br />State/Zip <br />Phone <br />� <br />Phone <br />�. <br />�� �a� ��1� <br />City of Everett Business License Number (required) <br />FEE � <br />�� � <br />6 <br />PERMIT# <br />ul�p�-�b2 <br />