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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 />oZ�,2C 7��� S r���� � i C�� ��7t�� <br />PROJECT ADDRESS <br />� <br />����� ��-�,��y �s�� ��� �� � � �v��;; ��� �- �� ��z>>���- ��� <br />Property Owner Mail Address City State/Zip Phone <br />Tenant Name (If this is for a commercial business) <br />{�'��, � -� ��u�tvrti� D�� 5 l'l%i-rr�i � <br />Contractor Mail Address City <br />�M ��� ��ar� � <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 />gnature <br />REVISED 11/19/2014 <br />(,��. ��'��� Cz�) zj�; - �; � <br />State/Zip Phone <br />D % , � :%�J <br />City of Everett Business License Number (required) <br />FEE <br />��Uv <br />PERMIT# <br />U � 5 03 - OC�� <br />