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��. <br /> -- - ---- — - --, <br /> UTILlTY �ERMIT APPLICATI�`1�V <br /> CITY OF EVERET7 PERMIT SER�.�IC1=S <br /> 3200 CEDAR STRFET, FVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-E857 —ww�v.everettwa.org <br /> � 2 ��a-��n a-��v' G1YU'2-�-t�" <br /> � PROJECTADDR�SS G�o���J <br /> � �' � A ���✓ (r/a- . �� 3 s'� l j <br /> 6 N N )o o-� �o I S�i�cs- � M ny pu� <br /> Prope�ty Ownei Idail Atldress Clty Stale/Z�p Pnone <br /> :Tenanl Name Qf '+ commerciai business) <br /> � <br /> ' �(.'� l.� 1P,r�.e l,« Pv ('�co�z g�,o , w�` - 9B29i 2°t� �l-0� os 'L9 <br /> Contractor Mau Adtlress Cily StatelZ�p Phone <br /> �-Itsvzo PP� S(o3 v 1 08-�3 3S _ � <br /> V�IA State Comractor License Number(required) C�ty of Everep Business License Number(required) <br /> i <br /> Work to be done: <br /> ❑ Side Sewer Repair <br /> ❑ Side Sewer Alteration <br /> ❑ Side Sewer — New Installation <br /> �Install Backwater Valve (outside the building) <br /> � ❑ Cap off Sewer <br /> ❑ Install Water Meter FEE ' <br /> 3 �� <br /> / ✓ �U - / � PERMIT# <br /> Signalure Dale � I� ��/� �� <br /> RC-195eD t In9701� <br />