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U�'ILITY PERMIT APPLICAT�ON <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERE.TT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857—www.everettwa.org <br /> ��2� ���y <br /> PROJECT ADDRESS �+�, <br /> `��r+-i� Le �,t-,�2ov� 1,b2� Co�G�u CU�Q.�T��t,v4• `!�I 2q 5-SSd 1 <br /> Property Owner Mail Address Ciry Slate2ip Pnone <br /> ���� <br /> Tenanl Name(It this is for a commercial business) <br /> (y25� <br /> � SS ��oG l�el�� �la �v��"LT- w a Q��o3 z�r�-- �a s9 <br /> Contrador MailAddress Ciry StalelZip Phone <br /> Q M'k.R� S� S�6 (, K f- r553 �'�8 <br /> WA Slate Contractor License Number(required) City of Everett Business License Number(required) <br /> Work to be done: <br /> ❑ Side Sewer Repair <br /> ❑ Side Sewer Alteration <br /> ❑ Side Sewer— New Installation <br /> 0" Install Backwater Valve outside the building) <br /> O Cap off Sewer <br /> ❑ Install Water Uleter <br /> FEE <br /> 30 °� <br /> � — "pUJ� PERMIf# <br /> Sig at Date � I � I ��7`1C � <br /> l ��J <br /> REWSEO if/19l10f� <br />