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- -- - ---- - ---- --- --- --- -- --� <br /> � ` , <br /> UTIILITY PERMIT APPLICATIQN ' <br /> CITY OF EVERETT PERMIT SERVICES <br /> , 3200 CEDAR STREET, EVEP,ETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 —www everettwa org <br /> �' �� �6 l�(rn�� <br /> I PROJECT ADDRESS I <br /> . <br /> � l� � o��l <br /> � �� �_1��� � . _�t�. 1.��__�l�vk�. � , <br /> Property Oemcr 'da�l 1dd�ess C��ty StateiZ�p pnone � <br /> Tenanl Name (If Ihis is`or a commercial bus���ess) I <br /> i�,�l,��� ��s��, . _D�� I`r4 �����o�. . G� ��2,7Z ! <br /> Con'racter P.;a�lt.dd�ess Cty Stal?�Z�p �'��o^e I <br /> (�1�� _Lc )�C l�,g F��'l �,1�/t C�S Z—�17 !� I <br /> � WA Slate Con!raclor Ucense Number(required; Ciry of[verett Busmess Llcense Number(reGuired) ' <br /> i I <br /> Work to be done: <br /> ❑ Side Sewer Repair � <br /> I <br /> ❑ Side Sewer Alteration i <br /> ❑ Side Sewer — New Installation j <br /> /1a' Install Backwater Valve (outside the building) I <br /> ��� I <br /> � <br /> ❑ Cap off Sewer <br /> I <br /> ❑ Install Water Meler -- � <br /> FEE <br /> � �J� � i <br /> �� � ��� jS PERMIT.Y <br /> � � � <br /> — S� tu Date ' 1 I �Q I — I �� <br /> U I <br /> n!¢i5F^+t.�a^�r� I <br />