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UTILITY PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 9B201 <br /> 42�257-8810 - FAX 42�257-8857—www.evereflwa.org I <br /> /y3,� � Go%c/ � <br /> PROJECT ADDRESS <br /> ras s ��G�S f��`t�aUr Cl��'����r,l� ��2� <br /> P�peKY� Mai Address GlY Sfate/Lp PM�e <br /> Tenant Name(If this is fa a canmercial business) <br /> �'���H�,�k�����"G�/�� v�S,b�aK.a �"v� �vQ 9�6g �/�s�/� y-ol� <br /> CorNractor Maii Address Ciy StatrJ7'p PM�e <br /> .�1t"�I L fl�- �� p ���a 0�7ss� <br /> WA State ConVaUor License N�mber(�equired) ' City ot Everett Business Limnse Number(required) <br /> Work to be done: <br /> ❑ Side Sewer Repair <br /> ❑ Side Sewer Afteration <br /> ❑ Side Sewer— New Installation <br /> 19'Install Backwater Valve outside the building) <br /> 0 Cap off Sewer <br /> ❑ Instali Water Meter <br /> FEE <br /> 30°`' <br /> PERMITJI <br /> Signature Datn <br /> U I�OZ- � D <br /> ,�„��,. <br />