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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 31 � ,��� y i ��� <br />PROJECT ADDRESS <br />� �' 1�re �f�k� � �-� -s� -;�� <br />P�operty Owner Mail Address City State/Zip Phone <br />Tenant Name (If this is for a commercial business) <br />��/��il/�.�/��.�ir�?ii � � �i�/ �?% ���� .<�,�i ��i,,- /'v i! r../i'�FG� <br />Contractor Mail Address City State/Zip Phone <br />��G�Lf�L %�.�L ; <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 />Signature <br />REVISED 11/19/2014 <br />Date <br />� �.� `�.Ss <br />City of Everett Business License Number (required) <br />FEE <br />���� <br />PERMIT# <br />U��D��O�C <br />