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From:Jennifer Baker Fax:(844)687-3837 •To: Fax: (425)257-8857 Page 3 of 3 01/27/2017 9:12 AM <br /> UTILITY PERMIT APPLICATION <br /> CITY OF E Y ERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857—www.everettwa.org <br /> P 17 ILA, <br /> PROJECT ADDRESS <br /> Prof rty Owner <br /> Mail Address City State/zip Phone <br /> 1 <br /> Tenant Name(If this is for a commercial business) O r <br /> Contractor Marl Address City State/Zip Phone r--- <br /> -6 -J)j <br /> WA State Contractor License tsrumber(req ired) City of Everett Business l-icense 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 /> J� <br /> � b <br /> Signature �� Date ( <br /> U 1 1 02- Jr� <br /> REVISED 11/19/1014 <br />