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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 /> PROJECT ADDRESS <br /> l 1 <br /> () ) cLaLti L , (--,vcr(.1+ 1,. /-‘ Y6d6 qa5 't);61Y6 <br /> Property Owner Mail Address City State/Zip Phone <br /> Tenant Name (If this is for a commercial business) <br /> L)c„as cLc.‘,1 J '1 �i% V-(,,,00(,- U1. t <br /> 00(,— ' 026 dole" M,0-7147 )Contractor J P6c-n Mail Address City State/Zip Phone <br /> WA State Contractor Licensed mber(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 /> Install Backwater Valve (outside the building) <br /> ❑ Cap off Sewer <br /> ❑ Install Water Meter <br /> FEE <br /> '0 <br /> % /-- v PERMIT# <br /> Signa ares- Date <br /> U <br /> ' 7 <br /> REVISED 11/19/2014 <br />