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. - 1 <br /> UTILITY PERMIT Af'PLICATION � <br /> CITY OF EVERETT PERMIT SERVICES <br /> 320D CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 -www.everettvea org <br /> I <br /> ���.� �. GC/�3�/ <br /> PROJECT ADDRESS <br /> /�l/e� � ro�,.�o <br /> Property Owner h7a�i Address C�ry Sta!e2�p Pnone <br /> Tenant Name(I(lhis is for a commercial business) <br /> I <br /> /��G//G�/CeirQ,n 5��7 7/f�9✓�.vG— �+G�LSviiiG wR" yS"s2� 3�� iSo7 <br /> ContraCtor MaJ Adtlress City Stale2p ?hone <br /> ��GGPG 9�3 L � oS3�/SS <br /> WA Slate CoMraclor License Num6er(required) Cdy of Everett Business License Number(required) <br /> Work to be done: <br /> ❑ Side Sewer Repair <br /> ❑ 5ide Sewer Alteration <br /> ❑ Side Sewer - New Installation <br /> l�1. Install Backwater Valve (outside the building) <br /> ❑ Cap off Sewer <br /> ❑ Install Water Meter <br /> fEE <br /> �\, 3�� <br /> / `�__ _ ��/G�/� PERMff# <br /> � SignaWre Date � I � O� O� <br /> FF1'i5E0 fln9^.JfJ <br /> _ _ <br />