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UTILITY PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, N/A 98201 <br /> 425-257-8810 - FAX 425-257-8857 — ww�v.everettwa.org <br /> �I�t � T) �rc.,�e% /�-t�e <br /> PROJECT ADDRESS <br /> �LHr� Olyo.n ����� �rwM� ��w �Ve��� i�� Iy�n'�ol �%2�� �i <br /> Property Owner I+tad AdCress Gty Siate2��hone <br /> Tenanl Name Qf Ihis is(or a canmercial busmess) • <br /> � ._, r��� div i ��� M� ��D�. �l �� i� 51���::� W�1, �,8�3� ��- ��—�4�� <br /> COMractor Ma�l Address Crty Stale2io Phone <br /> ���� �� �l l 6 I� 5 0 �� � 7 K�( <br /> WA State Coniracior License Number(required) ' Gry of Everett Business !icense Number(required) <br /> Work to e done: <br /> Side Sewer Repair <br /> ❑ Side Sewer Alteration <br /> ❑ Side Sewer — New Installation <br /> ❑ Install Backwater Vaive (outside the building) <br /> ��': <br /> O Cap off Sewer <br /> ❑ Install Water Meter <br /> FEE • <br /> , <br /> � oao <br /> PERMRk <br /> Signature Date 1 I l�O � O�� <br /> U � <br /> REYrSED iv�9R0iJ <br />