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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.everettwaorg <br /> PROJECT ADDRESS <br /> Property Owner Mad Address CIty StatelZlp Phone <br /> Tenant Name(If this is fora commercial business) <br /> Ali Plum bi <br /> Contracts- Cly StateOP Phuee <br /> • <br /> 6'7'1"1 pia r a I/ /J Z2 �tij <br /> WA State Contractor License Number(nod) City of Everett Business Linen- se Number(required) <br /> Work to be done: <br /> ❑ Side Sewer Repair <br /> ❑ Side Sewer Alteration <br /> ❑ Side Sewer-New Installation <br /> • <br /> lil Install Backwater Valve (outside the building) <br /> ❑ Cap off Sewer <br /> ❑ Install Water Meter <br /> FEE <br /> C)0 <br /> , '2-.�.� �/ �11i►�� 6/� PERMIT# <br /> I'Signature •ate <br /> U P; Ion <br /> ItEMED11/11121714 <br />