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UTILlTY PERMIT APPLICATION <br />� CITY OF EVERETT PERMIT SERVICES � <br />3200 CEDAR STREET, GVERETT, W.A 9.8201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />G%/ 9 /�o �% <br />PROJECT ADDRE S <br />l"�i.� �� > /%'I !� �v/ � /1'_ <br />Owner . <br />1•Aail Address <br />Tenanl Name (If ihis is fora commercial business) <br />��urh t� <br />Mail Address � <br />/'AM7O:T �GiZI'�S <br />WA Slate Contractor License Number (requued) <br />Wofk ip be done'. <br />❑ Side Seveer Repair <br />❑ Side Sewer Alteration <br />�?a. 55�f I <br />City . <br />�JC!/G� w� <br />.SlatelZip� � . . � � Phone <br />i� RFs7-� <br />� State2ip . . . . � Phone . . <br />Oy?703 <br />City�o( Everett Business License� Numbe� (required) <br />. �. <br />❑ Side Sewer — New lnstallation <br />- ,,:j <br />(]�Install 6ackwater Valve (outside the building) <br />v <br />❑ £ap off Sewer <br />❑ Install Water Meter <br />FEE <br />;'rS' `�. � <br />_-_' _ <br />��/ 0 � J�6/f��`. PERMIT#, . <br />� . . � Signature . � . .. . � . Dat___� _ � � � ✓� � � I � <br />�� ..,.. �i .. _.n.;<-.�,. _,:_-.� . ----�-.�..Tn-;;�• �.,.�.:_:� .:Zu. . - --� � <br />u.n.__.— .. � . � . ..�.. �... ....-.a. <br />�_ - �•....�.:,:.�- . . .....:. —._ . ... ..�..�:�. . .. . . _ . ... uG.r �.-�i�'"'^^'. z"- L`x`..:,_:, <br />