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• 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 /> i�"o,� Lo�h� ;A�r��c <br /> PROJECTADDRESS � Z�L,_ (�J—t�— <br /> �?� � CP 'L� rZ— <br /> 1 �to z ��Gi�y Hrt� �.`�.�� i.,,�� - 9,�2a3 <br /> Ptoperty Owner �da�l AOtlress � City SlatelZip Phone <br /> TenaN Name Qf Ihis is for a commercial business) ./ ��_�1L3 <br /> �Y�-I�� � <br /> � <br /> � „�� �r � � .. 9�,� <br /> ContrOCbr tdail ddress City State/Z�p Phone <br /> pl�l-�D'//� 1�,5 7 f SZv <br /> VJA St�tractor License Number(required) Cily of Everelt Business License Number(required) <br /> Work to be done: <br /> ❑ Side Sewer Repair <br /> ❑ Side Sewer Alteration <br /> ❑ Side Sewer- New Installation <br /> R-7" Install Backwater Valve (outside the building) <br /> fJ Cap off Sewer <br /> ❑ Install Water Meter <br /> FEE <br /> � �� <br /> ��f " l�l��S PERMITk <br /> Signature Date � � �O [ _��� �II <br /> J <br /> rtEwSED t rno2m< <br />