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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 /> 4�6 Vw' "I ok- . <br /> PROJECT ADDRESS <br /> AeD W2 7�;- <br /> Lci 0 A lo W Inda ' <br /> Property Owner Mail Address City State/Zip �f ` Ppee13 <br /> Tenant Name (If this is for a commercial business) <br /> ower <br /> � XrKIn' 147% hre 5 � / 52_�� feal <br /> Contractor Mail Address City State/Zip 1 <br /> ,')0610hone�� <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 /> ❑ Cap off Sewer <br /> ❑ Install Water Meter <br /> FEE <br /> 1 <br /> Z �5 PERMIT# <br /> Signat re Vate f U 1 5 0 � _ o i <br /> REVISED 11/19/2014 <br />