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i <br /> UTILB . Y1--i E '-MIT FA PPLICATIO <br /> CITY SF EV R TT PERMIT SERVICES • <br /> 0 3200 CEDAR STREET, EWERS t I,WA 98201 <br /> 425-257-8810 - FAX.425-257-8857—www.everettwa.org <br /> k• ---t4 . _k____ <br /> PROJECT ADDRESS - • <br /> C LC WSJ <br /> Sam.".AA L2 t ++. i 1 \ State►Zrp Phone <br /> Property Owner Mail Address <br /> City <br /> i(16i <br /> Tenant Name(Weds is for a commercial business) <br /> (Li 2 ) <br /> A., <br /> • « 2 r OC j4N y't j2, l IV-WE-T1 4;,) oL ` State) Phone <br /> Contractor <br /> Mail Address City <br /> M-,9,71. <br /> _ l <br /> A ,��.�t ,�� t �i`1 fir- City ofincense Number(required)tNA State Contractor License Number(required) <br /> Work to be done: . <br /> ❑ Side Sewer Repair - <br /> ❑ Side Sewer Alteration <br /> ❑ Side Sewer—New Installation <br /> Backwater Valve outside the building) <br /> Q�lnstail Bacltw t____---- <br /> 0"-Cap off Sewer <br /> ❑ Install Water Meter - FEE <br /> 4470 t <br /> / —221 —15 1 PERMIT# <br /> ►; _, ,l Date U 1 <br /> v. Sig ate/ <br /> nseoiinsrm7ra - <br />