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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 /> 2I2Li I2.4i/1j.er Aye <br /> PROJECT ADDRESS <br /> 'Joii,i / y u / ofl 2/2-1-/ gamier Ave Ejepe W4 5b. <br /> / <br /> Property Owner Mail Address City State/Zip Phone <br /> /-e ri �3rdce <br /> Tenant Name(If this is for a commercial business) <br /> . ;e-,7a/ic a/ 8/S <br /> /.2oajer 7vkk /a 1/49f/6 ?c ®.c�d9.9 <br /> Contractor Mail Address City State/Zip ��" one <br /> 727- a-7. <br /> WA State Contractor License Number(required) City of Everett Business License Number(required) <br /> Work to be done: <br /> 0'Side Sewer Repair itv- f 7�0 .Ae / laced <br /> ❑ Side Sewer Alteration <br /> ❑ Side Sewer— New Installation <br /> G2 Install Backwater Valve (outside the building) <br /> ❑ Cap off Sewer <br /> ❑ Install Water Meter <br /> FEE <br /> 00 <br /> 30 <br /> , AAA11r- I 2-0/ PERMIT# <br /> nature Dat: U [6 b ® I <br /> REVISED 11/19/2014 <br />