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_ . __ — - — - _ - - i <br /> � UTILlYY PEQMIT APPLICATION <br /> � CITY OF EVERETT PERMIT SERVICE� <br /> 3200 CEDAR STf�EET, EVEREI T, WA 98201 � <br /> 425-257-8810 - FAX 425-257-8857 – ��ww everetlwa org <br /> � <br /> � � �� I%... (� �v-e.r'e,�" �tl�} <br /> PROJEC7 ADDRESS �� � <br /> i5�.,.C. �� l Z�C� a�� �- �tn��'v✓� �1' �✓/�/��U � ���-I ��s� <br /> i <br /> PropCtty Owner 1.1a�1 Adtlress C�ty Stat /Z�p Pnone <br /> � Tenant Name pf Ih�s is for a com;�ercial business) , <br /> � <br /> �I v�1 �(,...���r�J 17SIS �►�VSF S�' S��':r� � Gt�`2 �� `�'�-7�o-�'3ca I <br /> Contractur //t.1ai Aadress City StalelZ�p Phc-�e <br /> n��� PP;� �b'3f0 d S 3 � 3 S <br /> !^!:1 State CantraUor License Nemher(required) Gty of[vereit �usmess license Nurnber (requ�red) <br /> Work to be done: I <br /> i ❑ Side Sewer Repair <br /> I <br /> � � <br /> ❑ Side Sewer Alteration <br /> � O Side Sewer - New Installation <br /> 1 <br /> �nstall Backwater Valve (outside the building) <br /> ❑ Cap off Sewer i <br /> i <br /> ❑ Install Water Meter — <br /> FEE <br /> 3�ao � <br /> � � � � o� - � S_ _ PERh1IT; 1 ', <br /> Signature Date � I C��� O� � I <br /> ' . — J ---=� I <br /> NCVI$EO 11/19.4011 � <br />