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. . <br /> ' - --� <br /> UTILITY PERMIT APP�ICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 4?_5-257-8810 - 1=AX 425-257-8857 -vrv�w.everettwa.org <br /> 1��Z ��m�1� I <br /> PROJECTADDRESS <br /> � � �✓v� P� "l�g �n� �en� �A)Q� �-�P� � l�-U�✓ <br /> Property�vner t.1a�lAtldress Gry StateiZ�p Pnone <br /> i <br /> � <br /> Tenant Name Qf Ihis is tor a commercial business) I <br /> /� I�,m� �OP.3 I � .�ISFi 1 O/O"� 1 L� l � I �� ��Dv_ 1!i/� � Y[-•/�-- <br /> LConiractcr 64ailAddress C�ty State!Z�p Phonz <br /> �,�,��t� �����L B�Lt L�^,� � 2- "7 8 <br /> '✓VA Stale Contractor License Number(requ�red) Cily of Everett Business license Plumber(required) � <br /> , I <br /> Work to be done: <br /> ❑ Side Sewer Repair <br /> ❑ Side Sewer Alteration <br /> ❑ Side Sewer- New Installalion <br /> �Install Backwater Valve (outside the building) <br /> ❑ Cap off Sewer <br /> ❑ Irstall Water Meter <br /> FEE � <br /> �/Jv �� � <br /> � Z�� � PERMIT# <br /> �naWra Dale 1 1 I� 0 I _ ' �� <br /> U <br /> �EViSLD f 1/raiz,;u <br />