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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 /> (PAct, V\oc V e 2- . <br /> ,PROJECT ADDRESS C <br /> 428) <br /> &CY-4A .0 Pt-ett,i1 Lbig ikjcVOL NIEMI1 W(1 gEot 2J-50 - tzct5 <br /> Property Owner Mail Address City State/Zip Phone <br /> iR0t1) <br /> Tenant Name(If this is for a commercial business) <br /> ' c3Q3 �� --cctsq <br /> " City Mail Address 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 Alteration <br /> ❑ Side Sewer-- New Installation <br /> /Install Backwater Valve (outside the building) <br /> ❑ Cap off Sewer <br /> ❑ Install Water Meter FEE <br /> —30 --- <br /> - -- a` '" 0— 1 0 PERMIT# <br /> Sig at Date U 1 6' / —407/07 <br /> REVISED 11/1912014 A <br />