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--- -- -- - i <br /> � <br /> UTILITY PERMIT APPLiC/�TION � <br /> ; CITY OF EVERETT PERMIT SERVICES � <br /> 3200 CE�AR STREEI, EVERETT, NJA 98201 � <br /> 425-257-8810 - FAX 425-257-8857 —wv✓w.everettwa org j <br /> i � <br /> I <br /> i <br /> '�,���, ��o�� ��� I <br /> I PROJECTADDRESS ' I ���_ j <br /> j 1fi�Ni� �i.� ���'- I-}��fi ����c" �R ���oJ o�'�I ' <br /> Piopeily0wner �AailAddress G�y State/Zip Phonc I <br /> �I Tznant Name (If ihis �s for a commercial business) �(�� I <br /> I �`��3 �6-� <br /> g�2�� o� ��e��y����l�cw�s u.�� �i�oa C� �ll�.� ' <br /> � COnirador h1ailAddress Cily Sta'erZ�p Phone i <br /> �� �b�fss g'��L�5 ��� g�o ��� <br /> : `A�A Stale Contractor Licen mber(required) Cily of Everett Business license Number(required) j <br /> I <br /> IWork to be done: � <br /> � ❑ Side Sewer Repair �I <br /> � I <br /> i ❑ Side Sewer Alleration <br /> I <br /> � ❑ Side Sewer - New Installation <br /> � <br /> � Instail Backwaler Valve (outside the building) <br /> � <br /> � Cap off Sewer ' <br /> � ❑ Install Water Meter FEE <br /> r �O ��I <br /> f �{ I � —___ <br /> � ` ` !Vl �i,�� 2— I I ���! � PERriR� -__— I <br /> ' paw�e� ----- oat� <br /> �- ---- � I�O z-D�� <br /> ��,_� �,, .,.� . <br /> I <br />