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UTILITY PERMIT APPLICATION <br /> CIS OF EVERETT P RMIT WA VICES <br /> 1 3200 CEDAR STREET, EVERETT, <br /> 1 <br /> 425-25741810 - FAX.425-257-8857—www.everettwa.org <br /> tr10 Ca <br /> PROJECT ADDRESS 2-5) <br /> - <br /> G ,, ,r q3 )(> <br /> . or � 'AA � State/MP Phone <br /> Property Owner <br /> 4 Mail Address City <br /> t7` <br /> Tenant Name(If this is for a commercial business) <br /> (1-125) cl <br /> „ r(1 IA) * cLE3a05 <br /> City State/Gp Phone <br /> Contractor Mail Address <br /> a 6 � �-- City of Everett Business License Number(required) <br /> WA State Contractor License Number(required) <br /> Work to be done: <br /> ❑ Side Sewer Repair <br /> ❑ Side Sewer Alteration <br /> ❑ Side Sewer-New Installation <br /> El/Install Backwater Valveoutside the building) <br /> O -Cap off Sewer <br /> O Install Water Meter <br /> bio <br /> I _. J PERMIT* <br /> j am— <br /> urzw- <br /> Sigig'ail, Date c \SDI 621 <br /> _ <br /> REVISED 11M9/2014 -. <br />