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UTILiTY PERiNIIT �4PPLICATION <br /> CITY OF EVERETT PERMIT SERVICE� <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-25%-8857 —www.evere!twa.org <br /> �o - L�U.� h���l �� <br /> PROJECT ADDRESS <br /> �G!/l �mv�^�//IGE� �' d���' �/ C!/C�' //`����_ <br /> PropeRy Owner Mail Address City SlatelLip Phone <br /> Tenant Name(If Ihis is tor a commercial business) <br /> flf� %lrr���u��< � ����- i��5r""��� /��-`� ,Crr��-�q�a�� — <br /> Contractor MailAtldress City S;aletip Phonc <br /> ���sy��-��,z 5 <br /> �fl�Lv�- �f o���r� o�'ss� <br /> WA Sl��e Coniractar License Number(required) City of Everett Business License Number(reqi�ired) <br /> Work tn be done: <br /> ❑ Side Sewer Repair <br /> ❑ Side Sewer Alteration <br /> ❑ Side Sewer— New Inst��llatio!i <br /> �nstall Backwater Valve outside the building) <br /> ❑ Cap o�f Sewer <br /> � Install Water Meter <br /> FEE <br /> �� � <br /> /� 'GL� � �41 -G � ` PERMIT# <br /> Signalure Date � <br /> 15oZ- roZ <br /> ntvisea iinvmw <br />