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UTILITY PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8610 - FAX 425-257-8857 —www.everettwa.org <br /> � <br /> �� � y E��,��� ,��� . <br /> PROJECT ADDRESS <br /> �oG�ti Co � hq�v�t Ev�i f� lsi� <br /> Ciry Slate2ip � , Phone <br /> prop�Ay Ownef � Mail Address - . � . <br /> // <br /> Tenant Name Qf this is fo a co ercial business) <br /> /� l_ l � Q � �l l^1�I11(,{. �Y'� .�J�� � �ilE�T2,Z I �Ca l 6 ��p <br /> (-a 1/�_�(�2 e' Cdy Stale2ip Phone <br /> COn�taClOf hlail Address � . <br /> �� n ;�«n � 1�i 17 �1S O �-i � 7 a 3 <br /> WA Slate Contractor License Number(reqwred) City of Everett Business License Number(required) <br /> Work t� done' <br /> ❑ Side Sewer Repair <br /> ❑ Side Sewer Alteration <br /> ❑ Side Sewer — New Installation � <br /> � Install Backwater Valve (outside the building) � <br /> � . ❑ Cap off Sewer . : , . <br /> ❑ Install Water Meter FeE . <br /> 80 <br /> � �0. � <br /> ,�{/lz� �� -�-. PERh1IT# <br /> �� Da�e U l�D� �o�� <br /> •� � S�gnature . <br /> oomccn�o�annu ' "."- <br />