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� - --- - <br /> �__ .- <br /> 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� �L. Cv1h <br /> PROJECT ADDRE S <br /> ���(,k ��• �r'!l(o co l hv �I.�/u' ' � l�✓� ��i Y�S-.1�1y-ovoy <br /> Property Owner tdad Address C�ry -7 StateiLp Phone <br /> Tenant Name Qf this is fcr a commercial business) <br /> Mu<n 1"�`.v.h� � ��S I.j '-/ s�SL CC S�o�.r--�•`l � �"��i�9 U � 76 O �3 G a <br /> CoN�ac�Or Mail Address . Gty State2ip Phone <br /> 053��5 <br /> WA Stale ConVador license Number(required) Cdy of Everett Business License Number(required) <br /> Work to be done: <br /> ❑ Side Sewer Repair <br /> O Side Sewer Alteration <br /> O Side Sewer- New Installation <br /> �Install Backwater Valve (outside the building) <br /> fJ Cap ofi Sewer <br /> ❑ Install Water Meter FEE <br /> Z%10t7 <br /> �J <br /> �� �'� Z - � s PERM�# ,1 <br /> Signature Date ��C� O �. O�4 <br /> �viseoi+��4:.u�a __ � I <br /> � <br />