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UTILITY PERMIT APPLICATION . <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-?F' a810 - FAX 425-257-8857–www.everettwa.org <br /> ���5 Co�b� , � <br /> PROJECTADDRESS <br /> r�� n1�},—� ��' .,�� 4,8C5 Co��i,� ���u� , (�25� 36Z — lg"1?o <br /> Property0�/ner MailAddress Ciry Steterzip <br /> l� <br /> Tenant Nama(If this is fof a wmmercial business) <br /> (425) <br /> � �� ��c�c � «!:� da cv��.� �� a �t��.o3 z��--�as9 <br /> Contractor <br /> MailAddress City StatofLip Phono <br /> � ;�'t��s 5� ar� t K �. ��3 ��8 <br /> WA Stale Contractor License IJumber(required) Ciry oi Everett Business License Number(required) <br /> Work to be done: <br /> O Side Sewer Repair <br /> ❑ Side Sewer Alteration <br /> ❑ Side Sewer— New Instaliation <br /> 0" Instalf Backwater Valve outside the building) <br /> ❑ Cap off Sewer <br /> ❑ Install Water Meter FEE <br /> � J 3 '— �� ' G(J L 5 PERMIf# <br /> Sig at o Dalo I 1 <br /> lJ <br /> nevisen�insrnfe <br />