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� <br /> - ----------- <br /> I -- - -- ------- <br /> _- -------- � <br /> � UTI�ITY PERMIT �PPLICi4�'ION <br /> CITY OF EVERETT P�RMIT SERUICtS � <br /> 3200 CFUAR S7REET, EVERETT, WA 98201 <br /> � 425-257-8810 - FAX425-257-885; —wvr�.everettwa.org <br /> � <br /> � <br /> � 2 �IGj Lv�� � � <br /> I PROJECT ADDRESS <br /> I 'r� Ccr•�-e ��-( (r-t �o•-,,lx, l tr�,�e� r/A- S,3'za I �l21 3ys"y2�1 �?7 <br /> Propert Owner ldadAddress City StatelZip Ptone <br /> � Tenant Name (II fhis is(or a commercial business) <br /> il <br /> �x/� (�� 5, l � � (�'�S/'S� ��J�..�.'? l _ Z-✓�` ��� �� 7�iL" ����c c� II <br /> Conir2ctOf i Mad Address Cd� Sta;elLp Pncne <br /> � <br /> M�,� P�',rYb'3Sc� D �" � � 35 <br /> `NA State Contractor License Number(reqwred) Clly of Everett 8usiness License Number (required) <br /> I <br /> Work to be done: <br /> ❑ Side Sewer Repair <br /> O Si@e Sewer Alteration <br /> ❑ Side Sewer — New Install�tion <br /> �Install Backwater Valve (oulside the bu�.lding) <br /> ❑ Cap off Sewer <br /> ❑ Instali Water Meter FE� <br /> ��6b <br /> � /� ',, ���� K�� �—IS PERMIT# , I �7 / <br /> Signature Date � I� D L�" _ I h'n <br /> � I / Y' <br /> ftEVI$[0 I V 19.20 i J _ <br />