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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 /> 1\ Lei vAM\I t�1 �.'a�.' . L c,-4LA4 Vl fi 1qi)1 <br /> PROJECT ADDRESS <br /> Property Owner Mail Address City State/Zip Phone <br /> Tenant Name (If this is for a commercial business) <br /> s_`/ 7 7/51fr-dve- g .r7e; ysvc,/e- +,✓A- �s�" ,7—/_C 7 <br /> Contractor Mail Address • City State/Zip Phone <br /> ,9o.? - G53 W s <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 /> (f2f. Install Backwater Valve (outside the building) <br /> ❑ Cap off Sewer <br /> ❑ Install Water Meter <br /> FEE <br /> --.- PERMIT# <br /> Signature Date <br /> U i —0L—C(15 <br /> REVISED 11/19/2014 <br />