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� -- - _ <br /> — _ _ ---- - _ _._ _ _ -- - -- — _ _ -- -- �i <br /> i I <br /> � . �iTILITY P��ttVIIT' �►PPLeC��l0�1 � <br /> �IYY AF EVERETT' PERMl� SERVlGC:� I <br /> 3200 CEDAR STREET, EV[RETT, WA 98201 i <br /> a25-257-8810 FAX 425-257-8857 -www everettwa org , <br /> I <br /> �.�I Z(v �ke� {�.e. - - <br /> PROJECT ADDRESS <br /> ' ��iiiC ��oNRlJ� Z12� 4�4 � �v 'L . `�V.W`�c-'V '' <br /> Prope�yOwner MadAddress City Slate�Zip Pnone <br /> �i tenanl Name pl th�s �s lor a commercial bus�ness) ' � <br /> ( atM�}/�� �7���.� I �i^1 (rlp1 't'� SJr�� �vF�t�_I.�14 ���_- <br /> C�r,tor'—'- -� �dad�ddress ,/ City State/Lp Phone <br /> � ' N t� 1;.1�N�S � y '7 � D� <br /> ! LNA Slate Conlracb�license Number(required) Gty ol Fveretl Business License Number(re�uired) <br /> I I <br /> Work to bc done: <br /> I <br /> ❑ Side Sewer Repair I <br /> � ! <br /> I ❑ Side Sewer Alteration I <br /> � ❑ Side Sewer - New Installation <br /> I � <br /> Install Backwater Valve (outside the building) : <br /> ❑ Cap off Sewer i <br /> ❑ Instail Watei Meter ' — -- - - <br /> FE� 30 °° _ 1 <br /> / —�---������-- PERMIT# --_. -� <br /> Signature . Date � � Ci J� � � J�/� � <br /> ,/lJ l.!`1� <br /> ;:�, SF,�,,,,�:o„ __. <br />