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UTILlTY PERMIT APPLICATION � <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8610 - FAX 425-257-8857 —www everettwa.org i <br /> 1 SO I l�3 �O��W�� <br /> I <br /> PROJECT ADDRESS <br /> ��.�Q �,���,, ��o � 3�,�o�fi,l�v� ��e��7T- � y�.�o, _ <br /> PrOperty0wn�t MailAtldiess Qry S�ate/Z�p Phone <br /> �-z��� 9S3 � ye.� � <br /> I <br /> Tenant Name pf Ihis rs lor a commercial business) �uG . I <br /> r+ <br /> Sc a�{� �'�i-7 l 't'. 20 ..1� ���R l.✓�'S� q'�i iG3 33/ -6SS 3 j <br /> Contraetor �dad Ad�ress Qty State2p Phone <br /> ��-1��4- 1\'7��' �� ��'} `( 1 �g <br /> WA State Contraclor License Number(re wred) City of Everetl Business License Number(requiredj <br /> Work to be done: i <br /> ❑ Side Sewer Repair <br /> ❑ Side Sewer Alteration <br /> I <br /> ❑ Side Sewer — New Instaliation <br /> �f Install Backwater Valve (outside the building) <br /> O Cap off SewPr <br /> O Install Water Meter <br /> F[E <br /> 2 O��i <br /> i <br /> J <br /> � 3 � ��{� z�I S� PERMIT# <br /> � a ure Datc � f � O�_ O�O <br /> � <br /> 11EV15E0 11/19?OfJ <br />