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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 /> 21 ?;"1/ S% -&- <br /> PROJECT ADDRESS <br /> Si21 i (Property Owner Mail Address City State/Zip Phone <br /> CrC-CL1 A- mak? <br /> Tenant Name(If this is for a commercial business) <br /> //OM ib 7LLL fi/ <br /> kj,_j'"-C"t�ez_t' _ �� _ <br /> Contractor Mail Addres City State/Zip Phone <br /> P tf 0 e 5-7 <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 /> nstall Backwater Valve (outside the building) <br /> ❑ Cap off Sewer <br /> ❑ Install Water Meter <br /> FEE <br /> 2L c S� <br /> l� PERMIT# <br /> Signature DateU 1 * —Deg <br /> REVISED 11/19/2014 a(/ I <br />