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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 /> �a v 3 / Lu w¢ // /2o�t� <br /> PROJECT ADDRESS <br /> �i�G/ro Z `��' ��C /o v 3� - VA/r�i.t� �4�.e N w S-r� /�//L�� l�ri� 9�'�7� <br /> Property Owner Mail Address City State/Zip Phone <br /> Tenant Name(If this is for a commercial business) <br /> Ci1�� a�T �V�re� <br /> Contr� 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 /> ❑ 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 /> z 3� ��' <br /> , <br /> /`��� �• /� � Z�Z3�/S PERMIT# <br /> Signature ate <br /> , <br /> U � �oL - � T� <br /> REVISED 11/19/20i4 <br />