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UTILITY PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, VVA 98201 <br /> 425-257-8610 - FAX 425-257-8857—www.everettwa.org <br /> i <br /> ��� ��v e,��� <br /> PROJECT ADDRESS C��"'� <br /> T ^�na 7 �f �.T� vJ� � L'�2-►z1� <br /> Property ner Ma�i Address Gry Siate2�p Phona <br /> l7 <br /> Tenant Name(If this is for a commercial business) <br /> (42'i� <br /> � 5� ��c�� Lue�;�, da c���� wa �t��o3 �.titi� �ns� <br /> Contractor <br /> MeilAddrass Ciry StatelZ�p P�a^e <br /> � ;�t'� �i. �� S�� K t— c553 ��l8 <br /> WA Stale Contraclor LicenseNum6er(reqwred) Ciry o(Everetl Business License Number(repuired) <br /> Work to be do�e: <br /> ❑ Side Sewer Repair <br /> O Side Sewer Alleration <br /> ❑ Side Sewer — New Installation <br /> Ef install Backwater Valve outside the building) <br /> ❑ Cap off Sewer <br /> ❑ Install Water Meter FEE <br /> �30� <br /> _ � - � - zv t 5 PERMCfJF <br /> $ig at� Oate � 150� - 03 �- <br /> atviseo rvivror. .__ <br />