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. 7. <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 —www.everettwa.org <br /> .1�/�I L'(el�ca2 S7 LllEl2cTf �� . <br /> PROJECT ADDRESS <br /> u� eo «/►n,�s 2?�1 C�sr��. sr Gv�n�`r w�a . 9B�i <br /> Property Owner Mail Address Ci�y State2ip Phone <br /> ,?Ob-¢OZ-Q$OS <br /> Tenenl Name(I(Ihis is for a commercial business) <br /> /�c�.o ��,NaN� P6 �3ax 887• S•.o�vr��sN �,,�•. 5?'lz91 <br /> Conlrador Mail Addreas City . SletalZip Phone <br /> ZD(t �Of� -0929 <br /> �:'¢bPPL$(o3 N1- oS3335 <br /> WA State Contractor LicPnse Number(required) City oi Everetl 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 /> 0 Install Water Meter FEE <br /> 30°0 <br /> I Z— $ ' I� PERMffA! <br /> -�~ Signat�re D81e I 1 I I I I � _�C ^) <br /> lJ �.r .J (i <br /> REVISED t1111R011 <br />