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. <br /> 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 /> C6f`h� o� I Di/ SC IOS� Com( SE <br /> PROJECT ADDRESS <br /> Ilir4i.ja Ca,r LLC i lq-z ( / 64-Lej ve - poi . M-01 , Jf gop-1 1z.c43g mt L <br /> Property Owner Mail Address City I State/Zip Phone <br /> Tenant Name(If this is for a commercial business) <br /> 1 .1'- is 12( - d"e-1404',\05' / 7 7 21 I// ° y farik/p qe o i - 1Z-13 -'441 <br /> Contractor Mail Address City State/Zip Phone <br /> FA cer.•0 8s--1 J 6 es-37 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 /> ❑ Install Backwater Valve (outside the building) <br /> ❑ Cap off Sewer <br /> r <br /> Install Water Meterrr rIct-- ( <br /> FEE <br /> -- 111# ' <br /> 110, 7 l <br /> 5.- ' <br /> PERMIT# <br /> Signa re Date U (507 0 1- <br /> r <br /> REVISED 11/19/2014 <br />