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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 /> -z6c)-3 n , <br /> PROJECT ADDRESS <br /> Property Owner Mail Address City State/Zip Phone <br /> i <br /> Tenant Name(If this is for a commercial business) <br /> P', C1 �V���—t c� . t 3 L1 Vic; Gf <br /> State/Zip Phone <br /> one <br /> Contractor Mail Address City <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 /> C`¢Install Backwater Valve (outside the building) <br /> ❑ Cap off Sewer <br /> ❑ Install Water Meter FEE <br /> PERMIT# <br /> Sig at et Date <br /> i <br /> REVISED 11/1912014 _ __ <br />