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� -- - - ---- � <br /> 'i 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 <br /> �0 6 G-ev�� r s � <br /> PROJECT ADDRESS <br /> il <br /> ZS� � <br /> /"L',� /i r+uii��iY 7 �� w�-r�o/G �`C__C✓c/�-if i,i,� �'�.� G/:.f � <br /> Property 0wner tda�l Adtlress C�:y State/Lp ��Gy�Phone i <br /> � T�ananl Name Qf Ihis is for a commercial Cusin�ss) I <br /> I �/yf � <br /> ' /��o/% /u� i S � v7 /•t" .c � v�ii �,,, ��c ��7 /S�7 <br /> ' CcnVactor .adAdtlress Cdy State2ip Phone <br /> I � <br /> , , -' GS3E S.� <br /> `N Stat�Contra lor���e umber(required) City of Everett G�s License Number(required) <br /> i <br /> � Work to be done: <br /> j ❑ Side Sewer Repair <br /> ❑ Side Sewer Alteration <br /> ❑ Side Sewer — New Installation <br /> ' � <br /> � Install Backwater Valve (outside the building) <br /> � <br /> I <br /> i ❑ Cap oif Sewer � <br /> ❑ Install W;�ter Meter FEE <br /> 3D°b � <br /> , G/, /,� PERh1Cf# <br /> Signature Date � I rr T I �D�3 <br /> �.� t'�J U I <br /> .1'FED f tn9Yiu _� <br /> �. —_ __ --__ _-___.___ _.__ _—'_'—_—__ __ <br />