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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 /> p<-y\ Cv 1 enc.-, 4�s 3�� 3 <br /> Property Owner Mail Address City State/Zip Phone <br /> Tenant Name(If this is for a commercial business) <br /> ire; 124.41/h iiy (7 s! S K I 1-1- si sr= 1-04 S 7 g 366 <br /> Contractor Mail Address City State/Zip Phone <br /> imoeciPix= 350 OS363 <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 <br /> FEE <br /> 3c ° <br /> c7r/A71-71/ f I PERMIT# <br /> Signature Date <br /> UISOr — � z <br /> REVISED 11/19/2014 <br />