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. <br /> UTILITY PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETi', WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 –www.everettwa.org <br /> � — <br /> .X O2. `Z�.v,ic�zT �� <br /> PROJECT ADDRESS <br /> �,1 ✓dL L�� "��OZ �-��-N��9r� ti.Gsetif �.<.�i� <br /> P�opeAy�wne� T Mail Addmss City Stale/Zip Phone <br /> Tenant Name(If Ihis is for a commercial business) �l�� r ���I_Z <br /> .-1-� 3 <br /> �-�/,�, 6,�-�.9 �c� ,P� l� Uir�-��ai��9-1- �-c�-i G�- <br /> Contractor M Addmss City State/Zip Phone <br /> 64i� f/�v ��'Q//P� ��7S.S�o <br /> WA State Con ctor License Number(required) City of Everetl Business License Number(required) <br /> Work to be done: <br /> ❑ Side Sewer Repair <br /> ❑ Side Sewer Alteration <br /> ❑ Side Sewer- New Installation <br /> stall Backwater Valve outside the building) <br /> ❑ Cap off Sewer <br /> ❑ Instali Water Meter <br /> FEE • <br /> �� . ��O <br /> � 7 '�-j Z�! 5� PERMIf# <br /> ure Oale � r J O , / ^ ( ( ' �l <br /> ��� �'�" � �l V <br /> � <br /> �stn�rna�o�� . <br />