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� <br /> UTILITY PERMIT APPLOCAT I <br /> ION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - 1=.qX 425-257-8857 — www.everethva.org <br /> � <br /> I , / � f <br /> � � �� H/�VT <br /> PROJECT ADDRESS <br /> ao,� �o/�..an <br /> Property Owner M11aii Adtlress Ciry State2p Phone <br /> ' <br /> � <br /> — I <br /> Tenanl Name p�this is(or a commercial business) � <br /> �o�o �'�u� ;�r � <br /> iC ntractor P.t�d Adtlress C�ty State/Z�.p Phone �� <br /> � /1on//9�903�.T <br /> IWA Slale Contractor License Number(required) City of Everett Etusiness License Number(required) ��, <br /> � �'���� <br /> IWork to be done: � <br /> � ❑ Side Sewer Repair <br /> ❑ Side Sewer Alteration I <br /> ❑ Side Sewer — New Installa!ion <br /> �Jnstall Backwater Valve (outside the building) <br /> ❑ Cap off Sewer <br /> ❑ Install Water Meter <br /> FEE <br /> � 3D. �� <br /> ��dd- /S PERMIT» <br /> 'ignatu Date � i vr� Q�_ I ^/� <br /> / �� <br /> revi5=!�r vre-ai� <br /> _ _. ". _'—'_'".."--_-- —_.... .. _..—__"_ _ _—_'____ __—' _"_—_ —.—_'__J <br />