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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 /> I <br /> PROJECT ADDRESS <br /> y o'1 <br /> Propert wner Mail Address City State/Zip Phone <br /> Tenant Name (If this is for a commercial business) <br /> �Y <br /> rva"w'JG.+�Jy�I �y t�/;11 rti �v1r— y'i%C f", T2s - 7?3-2Z5- <br /> Contractor Mail Address City State/Zip Phone <br /> z5� 12z B 4 03 771 z-� <br /> WA State Contractor License Number(required) City of Everett Business License Number(required) <br /> Work to be done: <br /> V 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 /> PERMIT# <br /> Signature to <br /> REVISED 11/19/2014 <br /> I <br />