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r----- ------- -- - <br /> UTILITY PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CGDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 - www.everettwa org <br /> i �L�G � (T'�Yt'�tt� A!//� �vtre // <br /> PROJECT ADDRESS <br /> J�/f�'��'���/Joh � V �(�ciT�/�rr't �l YvU r'�Yl.f� 3 � c W/T. ��Z y� <br /> Property Owner f.lail Adtlress C�ty Slate2�D Phone <br /> I Tenant Name Q(Ihis is`or a commerclal business) <br /> � <br /> G✓� Lt,.�r�� 4JY�S7 �d I�DY � / /� �ONr•�c �/� ��Z7 � I <br /> Conirad0� t:iaii Atltlress Gry StalelZip Phone <br /> � �,,,EL r,.��� L �� �>�M G'r Z 77� <br /> WA State Con,ractor Licer.se Number(required) Cdy of Everett Busmess License Number(required) <br /> Work to be done: <br /> Q Side Sewer Repair <br /> O Side Sewer Alteration ! <br /> ❑ Side Sewer - New Installation <br /> CxL Install Backwater Valve (outside lfie building) <br /> ❑ Cap off Sewer <br /> I <br /> ❑ Install Water Meter FEE <br /> �b�� <br /> , <br /> 2-Z G "/S PERr�rr» <br /> S�gna�ure Date � I �O�^ I I � <br /> FH'i5[O f In9?T I <br />