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i . - - � <br /> UTILITY PERMIT APPLICATION I <br /> I CITY OF EVERETT PERMIT SERVICES � <br /> 3200 CEDFIR STREET. EVERETT, WA 98201 I <br /> I425-257-8810 - FAX 425-257-8857 —�wnr�.everettwa.org I <br /> � I <br /> ' /3 /� Gc/T3y I <br /> PROJECT ADDRESS <br /> � _ G� Gun4_ <br /> Froperty OwnCr ��lail Atltlress Gry Statei7:p Pnone <br /> � <br /> i I <br /> � i enan;Name pf this is for a commercial business) � <br /> I • <br /> I /�'/�G//U P/u/�I��irs S �/�7 7/�A�e �.: r�c:iySv,ii� w/�- �S��:i 337-'/S�7 <br /> � <br /> �i Contracter fJan Aedress City State2ip Pho�e <br /> /�f oG G PG �03 G7' oS3�is s <br /> , \h'A S'ate Contractor License Number(required) City of Everett Business License Number(reqwred) <br /> � Work to be done• <br /> � ❑ Side Sewer Repair <br /> � <br /> � ❑ Side Sewer Alteration � <br /> i ❑ Side Sewer — New Installation <br /> i <br /> I � <br /> � <br /> �Install t3ackwaler Valve (outside the building) I <br /> ❑ Cap ofi Sewer <br /> I � <br /> ❑ Install Water Meter I <br /> FEE <br /> �� ' <br /> —_._. 3���/�/� PERh11T1. <br /> - Signature Date � i�O� _ I D� <br /> I <br /> FEc;Sen�vrui:07a � <br />