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� � �- 11TILITY 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 /> � � � � � � � ���� <br /> PROJECT ADDRESS <br /> Ci E-evtn �r` rk7.i � 131 Crn... L /dv�- I''w�l l,./11' �i�_Z o 1 <br /> Properly0wner p MadAdtlress Cily SlatelZ�p Phone <br /> Tenant Name (It(his is for a commercial business) <br /> �vu�l�l�,,,ti, J 7 � S yi�" s� r 5. ���c �� S�S� N2 s ����36u <br /> Contractor I.7a�l Address C�ty StatelZ�p Phane <br /> r��� P�'��'�'��v ps ��s � <br /> WA Slate CoMractor License Number(required) City of Everett Business�icense Num6er(required) <br /> Work to be done: <br /> ❑ Side Sewer Repair <br /> ❑ Side Sewer Alteration <br /> ❑ Side Sewer - New Installation <br /> � <br /> Q� Install Backwater Valve (outside the building) <br /> ❑ Cap off Sewer <br /> ❑ Instail Water Meter <br /> . FEE <br /> �" ��.�� <br /> �l� / 'Z� �'I ' �ji -� I � PERMITlt I <br /> Signalure Dale I I 1 �{��,�O� ' ^ <br /> LJ `�� l� (�lY <br /> F[�^SED i fn?OO» <br />