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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 /> 2 f/e3 lnci1/c- 7 i7 /9G"e <br /> PROJECT ADDRESS <br /> - / r� / a *--z7o <br /> )� <br /> R /"6 74 P'elopi��`4 LG c 77/y 77 /L /t/ 1j1�ry5v,/6 id/4 4'2c-33o-E7. <br /> Property Owner Mail Address City State/Zip Phone <br /> Tenant Name(If this(is for a commercial business) <br /> !r� rra LLC E7Zz X417 Aue /1/6 6;11,//4 earl; L:1/i Z.c2 2o("-92c- 943 <br /> Contractor Mail Address City State/Zip Phone <br /> F qp <br /> WA State Contractor License Number(required) City of Everett Business 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 /> XCap off Sewer ( /vcdsrz lac✓no 4-lie-) <br /> ❑ Install Water Meter <br /> FEE <br /> A, <br /> 77 2Z// PERMIT# <br /> Signature /at U 5.014411 <br /> REVISED 11/19/2014 <br />