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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 /> 231y/ <br /> 2s <br /> PROJECT ADDRESS <br /> 2f- <br /> 2 i 2rPe- Y r L.+ Cc-7-0( e773 v-7./1"— <br /> Property Property Owner Mail Address City State/Zip Phone <br /> Tenant Name(If this is for a commercial business) <br /> oe P/U441hf•rn (75jS L-(IsrS- S 5'10At's� (44 CikZ b S7i. 36o <br /> Contractor if 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 Alteration <br /> 0 Side Sewer— New Installation <br /> Install Backwater Valve (outside the building) <br /> ❑ Cap off Sewer <br /> ❑ Install Water Meter <br /> FEE a <br /> 11-7 <br /> j S/ PERMIT# <br /> Signature Date U 5.(k -006 <br /> REVISED 11/19/2014 '�J <br />