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i <br /> . a <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—wvuw.everettwa.org <br /> itz- 4lAko . ., <br /> cL,,-,,,-, <br /> PROJECT ADDRESS <br /> 112- weik-vAz NTEitz-F_A-t- 3 ° - 6'ett <br /> CIS, c, t G 4,o <br /> Propett Owner Mail Address City State/Zip Phone <br /> Tenant Name(If this is for a commercial business) <br /> (L-i 25) <br /> 5„ a‘O( LC4 c112, 6k1 4t ,Q c.i ; qi 3 zt'i-i:--geisq <br /> Contractor Mail Address City State/Zip Phone <br /> A E?..---- ',0GL X4,3 5 463 <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 /> ❑ Install Water Meter FEE <br /> (6 •-- W C. ...... <br /> �`+ .i---- t3 PERMIT# <br /> 9 .> W, . Date { � I J� � <br /> Si at 1 V O2 <br /> REVISED 11/182014 <br />