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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 /> ,PROJECT ADDRESS <br /> NZ 5 <br /> Property Owner Mail Address City State/Zip Phone <br /> i <br /> Tenant Name(if this is for a commercial business) <br /> CLi 2-15) <br /> S <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 /> ❑ Side Sewer Repair <br /> ❑ Side Sewer Alteration <br /> ❑ Side Sewer— New Installation <br /> Id Install Backwater Valve outside the building) <br /> ❑ Cap off Sewer <br /> ❑ Install Water Meter FEE <br /> 093U <br /> r-- � ` ✓ PERMIT# <br /> Sig at a Date 1 1 ( Sf1a�,0/_3 <br /> REVISED I M92014 <br />