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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 />% ��C'L � ' ( �� ' � �=1'��,� L` � � � � <br />PROJECT ADDRESS <br />� �� � � ���C��i � ��%� ���� �� L L � l%L�' i�'����� `� <br />Property Owner Mail Addre s <br />� I� <br />Tena t Name (if this is for a commercial business) <br />�� / j%%r� ,7 . c L �-�5�� ���� �� <br />Contractor Mail Address City <br />� �.� �==� �= � . <br />WA State Contractor License Number - quired) <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 />i <br />� Cap off Sewer <br />�� <br />� <br />❑ Install Water Meter <br />, <br />�� r;���- <br />' nature <br />REVISF_D 11/19/2014 <br />City <br />�v-�//�/� <br />Date <br />State/Zip �. �one <br />��� � 7,�>• 1< <br />�— C�C�c��� ���'e ��� ,� <br />St� /Zip ' ne <br />����- �� �j,CS <br />-������� <br />City of Everett Business License Number (required) <br />FEE 'l <br />� lV .�V <br />PERMIT# <br />U � S6(� (� S� <br />