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� � <br /> 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 /> .� � G' � C--c� � t,� �w �v� � �c <br /> PROJECT ADDRESS <br /> . � � <br /> ;����� � � �' ��>� .(� � « � ��v ��� ,� �z � y��T ������.��� ��-�� ����� <br /> Property Owner Mail Address City State/Zip Phone <br /> /�L>1�- <br /> Tenant Name(If this is for a commercial business) <br /> �v/�� <br /> Con actor 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 Aiteration <br /> ❑ Side Sewer — New Installation <br /> ❑ Install Backwater Valve (outside the building) <br /> ��Cap off Sewer <br /> ❑ Install Water Meter <br /> FEE <br /> � ������ <br /> � �� <br /> - Z zC'�5 PERMIT# <br /> Signature D � •'�` <br /> l`���-�� <br /> REVlSED 11/19/2014 <br />