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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 /> % 1,1),A # <br /> PROJECT ADDRESS <br /> /t'1:C11.4./ gra Sit ict ff r, e--/ GoA '?S' 20/ - <br /> Property Owner Mail Address City State/Zip Phone <br /> Tenant Name (If this is for a commercial business) <br /> Contractor 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 /> ❑ Side Sewer — New Installation <br /> ❑ .Install Backwater Valve (outside the building) <br /> ❑ Cap off Sewer <br /> ❑ Install Water Meter <br /> FEE <br /> 3/23 //C— PERMIT# <br /> Signature Date U l ^o w 9 <br /> REVISED 11/19/2014 <br />