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�- ---- -- -- <br /> UTILITY PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98?01 <br /> 425-257-8810 - FAX 425-257-8857 —www.everettwa.org <br /> 2 � U Z G ro.�c� /-� v -2 <br /> PROJECT ADDRESS <br /> �c. �n ; e � L��c�� 2102 G r��d �( �m <br /> Property O�vner h1aJ Adaress City State/Z�p Phone <br /> N I �- <br /> Tenanl Name(If Ihis is for a commercial business) <br /> SP ;�� r �r� Pvrc��Y L�c �0 3ov 34 �5 Ly�nwoo�P, wASfiov� �06_ <br /> Contractor Ma�l Adtlress City SlatelZip Phone �U-'�r,, <br /> S'P�..�e r-� l `I I (� ��S y � <br /> 6 � --�-� G � <br /> WA Siate Contrador License Number(reqwred) Gty of Everett t3usiness license Number(required) <br /> Work to be done: <br /> ❑ Side Sewer Repair <br /> ❑ Side Sewer Alteration <br /> O Side Sewer — New Installation <br /> �1 Install Backwater Valve (outside lhe building) <br /> O Cap off Sewer <br /> ❑ Instail Water Meter <br /> FEE !�, <br /> �uv <br /> �'3'I s PERMIT# <br /> Signature Date I I I ��� _ Q �� <br /> 11 <br /> RE��SEo tti�9ROfa <br />