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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 /> L0 5 F .4s, ��y <br /> PROJECT ADDRESS <br /> C LYt, <br /> (O V\k' 44 a 6- V, lir s - o EUEQ,Ert et0 — cB53 <br /> Property Owner Mail Address City State/Zip Phone <br /> In O VW, <br /> Tenant Name(If this is for a commercial business) <br /> ('-/2`� <br /> Contractor Mail Address City State/Zip Phone <br /> WA State Contractor License Number(required) City of Everett Business License Number(required) <br /> Work to be done: <br /> [9' Side Sewer Repair <br /> ❑ Side Sewer Alteration <br /> ❑ Side Sewer— New Installation <br /> Err Install Backwater Valve (outside the building) <br /> ❑ Cap off Sewer <br /> ❑ Install Water Meter ", <br /> FEE <br /> 4c2, <br /> 30 <br /> PERMIT# <br /> Sig'at .e Date p 00 <br /> (4=7 <br /> REVISED 11/19/2014 <br />