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- � ' IJTILITY PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 -www.everettwa.org <br /> �_,� � �2��-� L�. <br /> PROJECT ADDRESS <br /> �t� t�,�'1�(�� �70 3 ���►r� Hu= �-�-�t ��' <br /> -� <br /> Property Ovmer Pdad Atldress Cdy StatelZip Phonc <br /> Tenanl Name Qf this is(or a commercial business) �7 j-�� Il 9 .� <br /> O <br /> v �L � <br /> .�z�%��« �r�_,—_��'lo // �/����n�- /f�7��,i � <br /> Contracior lda�llLd�ss City Slatc2�p Pnone <br /> � <br /> ��-��--/��D c��� :�S C� <br /> WA Stale Contractor License Number(required) Ciry o(Everelt Business License Number(reqmred) <br /> Work to be done: <br /> ❑ Side Sewer Repair <br /> ❑ Side Sewer Alteration <br /> ❑ Side Sewer - New Installation <br /> all Backwater Valve (oui=�de the building) <br /> ❑ Cap off Sewer <br /> � Install Water Meter <br /> FEE <br /> 30 °" <br /> __ �7 C� / - Z.O I S PERMIT,'t <br /> S�gn e ale 1 1 r �o� _ O�� <br /> UI <br /> REw5E0 f f/19�.01J <br /> (. <br />