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,,` . <br /> -- -- ---- -- ---- i <br /> UTILITY PERMIT APPLICAT'ION I <br /> CITY OF EVERETT PERMIT SERVICES � <br /> j 3200 C[DAR STREET, EVER[TT, WA 96201 <br /> 425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br /> I <br /> i <br /> / Z 3 Z U✓'n�,✓ f�� i <br /> I PROJECT ADDRESS <br /> � /3 R r[3 l�ti� �..� 1Z 3 t G-�r..,�f�vis- �v��.�.9f` `�'�z.o i i <br /> � Property Ovmer ldad Address Ct7 Slale�Lp Phone <br /> � <br /> I I <br /> Tenant Name Qf this is(or a commercial business) I <br /> � <br /> I �j.1 �z L f,.�CST G:r� s fi f�e f10 r l`1`r/ /I'4�t, a.>+� w�+ �f f 27 Z I <br /> ICoNractor hlail Atltlress C;:/ State.2�p Phone � <br /> � ZL I <br /> w r� w i� C �- f�y �l � n� D"S- 1 -7 8 <br /> Vi�A State Contractor L�cense Nunber(requirzd) City of Everetl Business License Number(required) <br /> I <br /> Work to be done: <br /> � <br /> ❑ Side Sewer Repair � <br /> � <br /> ❑ Side Sewer Alteration � <br /> I � <br /> I <br /> ❑ Side Sewer - Ne�v Installation i <br /> I <br /> � Install Backwater Valve (outside the building) I <br /> ❑ Cap off Se�ver � <br /> i <br /> I <br /> ❑ Install Water Meter <br /> FEE <br /> ?�� 0 0 <br /> � <br /> �'�GrC�/y�-- / 27 j s PERMIT# <br /> S�gnature , Date � I!-��/ � /�, / <br /> � � f ! `7 <br /> newseo�vis�nu <br />