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. <br /> • <br /> UTILITY P�RMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVlCES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 —www.everettwa.org <br /> �� 5pb c�� ( <br /> /y�o �v�l , �.'�r�-i �� <br /> PRO ECT ADDRES$M � <br /> _ ut�� G-� D G-� '��r�/L�' ��P- �5�� (o�� <br /> Propehy Ovmer Mail Address City StatelZip Pnone <br /> Tenant Name Qf Ihis is for a commercial business) <br /> �'r�° Pl� �orv_i�t.��_�l� �i Uf..����'-�-- �i ����'��'� <br /> T� Cil Slate2i Phonc <br /> Contractor Ma Address y P <br /> �-'�`�L��O�//1�� �(�� � S� � <br /> VA _tate ontrac�or License t�umber(required) City of Everett Dusiness License Number(required) <br /> Work to be done: <br /> ❑ Side Sewer Repair <br /> ❑ Side Sewer Alteration <br /> ❑ Side Sewer — New Installation <br /> nstall Backwater Valve (outside the building) <br /> ❑ Cap off Sewer <br /> ❑ Install Water Meter ---- ---- <br /> FEF <br /> ��D c� <br /> -- -- �,-( l_--- / S-__—��FkMITi!_—�=/�f`7 — <br /> i V-1 1 <br /> . ignaturc ��� <br /> U �50�- � <br /> ,:,,,�„�,�,�, �., - <br />