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- --- - --1 <br /> U �TIL.IT� PiERMiT A�P'LiC�4TiOf� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STR[[T, L=VER[TT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 —vr.wd everettwa org <br /> i � ��G Z lTn'Tvr/ �z, <br /> PROJECT ADDRESS <br /> ,3,�►�/ sT � 1''�i �y� Z �^�►'^� �-�,+� ,�,YE��cT �/� P� Z v � <br /> Property O�vner Rta�t Adtl�ess Cdy StateiZ�p Phone <br /> � .� d s��r �-t� � y� z <br /> Tenant Name Q(this �s tcr a cornmercial bus�ness) <br /> �./ C L L.�(z� cG�...5:t' � /3o f /►!5/ /1�t,.r�, rv n Z.�. �l''�7 Z <br /> ContraCtor AtadAddress C�.ty �'ace!Lp Phone <br /> r,� � � wr-c � �� yL ,� �sty �� <br /> WA State Contraclor License Number(rea::ired) City of[verett�usmess License Number (required) <br /> I <br /> IWork to be done: ' <br /> ❑ Side Sewer Repair <br /> � <br /> I ❑ Side Sewer Alteration <br /> � <br /> � O Side Sewer — New Installation <br /> I <br /> �Install Backwaler Vaive (outside ihc building) <br /> ❑ Cap off Sewer <br /> I <br /> I <br /> � ❑ Install Water Meter <br /> FEE <br /> �� Oi <br /> _�?���/(�— �' � 7 ' � 5�_ PERMITk <br /> Signature Oate • � I �Q I _ I �� <br /> PcVic[o�vrP�oN <br />