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UTILITY PEt�MI"�' APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />320C CEDAR S �REFT, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www everettwa org <br />I <br />I ``�L�f l� �.Zv\cc�d C'�Si �J9.fz�T <br />I, PROJECT ADDRESS <br />jJo�-r ? �0.� - <br />Property Owner h7ail Address Cdy <br />Tenant Name p( this is for a commercial business) <br />�'��,�'s-�Iwm�,�T-- Pa �s5Y1 <br />Contracior A1ad Adaross/ C�ty <br />c�.� r�e i 4 i��S <br />`,^JA Stale CoMrar�or License Number (reqwred) <br />II Work to be do�e: <br />i ❑ Side Sewer Repair <br />❑ Side Sewer Alt��ration <br />❑ Side Sewer - New Installation <br />C�7 Install Backwater Valve (outside the building) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />� <br />N[L"I_`C 0 1 rilc/j01i <br />StatelZ�p <br />Phonc <br />Q �� �" 4 � � �—� � <br />SIa1C.�Z!P PhOne <br />� <br />, <br />City cf Evere�t Business License Number (required) <br />FEE � <br />�D 6, <br />f'tKMI I � <br />- u �5�3-o��f <br />