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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 /> 3ci 7^7 120Z1z-e- <br /> PROJECT ADDRESS 2-CY - i & <br /> -77S-ti <br /> Property Owner Mail Address City State/Zip Phone <br /> Tenant Name(If this is for a commercial business) <br /> p(tr),,_110( v-v_ i_Lc oc- oo trzi7eutice---g <br /> Contractor Mail Address City State/Zip Phone <br /> ce <br /> A taeoC ntractor 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 /> 4-6004 <br /> / {. <br /> �'' PERMTT# <br /> is nature gate U 151k- 0;4 <br /> REVISED 11/19/2014 <br />