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- ----__-- _ — <br /> — — ---- - ----- -__ __ _ --- <br /> r- — . <br /> I <br /> � ' UTILITY PERMIT APPLICATION <br /> � CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR SIREFT, EVERETT, WA 98201 <br /> 425•257•8810 - FAX 425-257-8857 - www everettwa org <br /> � t� � � Cle ve 1�..-� Z A-v�. _ <br /> PROJECT ADDRESS <br /> �— — a `-i16 �<<s,�_is.. z_�,t�_„�,�±_ �.-,.+ 4s-z r, r <br /> --�-�- --- - -- — <br /> Property Owner Mad Adaress Gly State�Lp � d 6 ?y�PA���7 <br /> > <br /> Tenant Name (II ih�s �s lor a commeraal business) � <br /> M tn l�w,�, —���5��`—I�S�'---5�..:L,e�,, t�, _ w U 25� �l S� 7W 8' S c u <br /> COn�ractor Ma�l Address C�ly Stale�T.�O Phonc <br /> n��� PP-� �Ss3�o _ o S � � � i <br /> WA S�ale CoNracicr License Number(requreA) Cily ot Everett Ausmess L�cense Number(reqwred) <br /> Work to be done: <br /> ❑ Side Sewer Repair <br /> ❑ Side Sewer Alteration <br /> � Side Sewer - New Installation <br /> � Instail Backwaler Valve (outside ihe building) <br /> ❑ Cap o(( Sewcr <br /> ❑ Install Water Meter — — — - <br /> F[[ <br /> � 3 p.a� <br /> --- <br /> _ _ _--- <br /> � � y – �7 ' � � PERMIT# <br /> – ----- _ - -- <br /> S�gnalure Datc � ��(� �0� <br /> �/ <br /> n[viSFo r rn9pou <br />