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, -- ------ — - -� <br /> UTILITY PERMIT APPLICATION <br /> � CITY OF EVERETT PERMIT SERVICES <br /> I 3200 CEDAR STR[ET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 —vrrrN.everettwa.org <br /> I <br /> I <br /> ' /�/3 Z G-�'� � /4 v� c��-rt- <br /> PROJECT ADDRESS . I <br /> I <br /> �i 20 L t� Sr� �rLE� �/}ml /G 1it.�'i/ YZ} 7Sb'�a��� <br /> Ptoperty Owner Ma�l Address C�ry Statc2ip Phone <br /> I <br /> Tenant Name Qf Ihis ;s for a commercial business) i <br /> I�FLc✓Fsr ��„s7 i'��3 � /9S/ �i� „v � c� �} T�z�z — � <br /> CoN�Bctor 1�1ad AdCress C�ry StateiLp Phone <br /> � i,.� F � c,� r- �� �� �� � ��, oS z�r7st <br /> II WA State Comracror License Number(reqwred) City of Everetl Business License Number(requ�red) <br /> Work to be done: <br /> ❑ Side Sewer Repair <br /> O Side Sewer Aiteration <br /> i <br /> i ❑ Side Sewer — New Installation <br /> I <br /> � ,�Instail Backwater Valve (outside the building) <br /> ❑ Cap off Sewer <br /> ❑ Install Water Meter F[E <br /> — <br /> 30a� <br /> �/l. `—' � �Z �'-�S PERh1ff� <br /> Signawre �' Datc � I � O "') I I � <br /> C.._ <br /> I. Pi:':i5E0�Vi9^Oro__ ._-_ —._' ._-- _--_—____ _ _ -______.--__ _- <br />