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UTILITY PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 —www.everettwa.org <br /> l la� M�s-� <br /> P OJECT ADDRESS �'�S - <br /> � �v� � � � la� N�l�-s�� ���f w� lG�o� �s <br /> Prope�ty Owner � Ma�l Address City S atelZip Phone <br /> ' v /� _ <br /> Tenan Name (If this is(or a commercial business) Q6 <br /> ��s�l���� ��6s. <br /> r�d .�.� '�'�a3 .�3�+a �{..�w, ��,� (,�A- ���� I la3 <br /> Contractor ldailAddress Cify SI te/Zip Phone <br /> sa�SS �.2- �� �5'.1��v <br /> WA State CoNraclor License Nu (required) City of Evemtt E3usiness License Number(required) <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 <br /> FEE <br /> �O� <br /> �C�Y�._/ � � � ��� PERMIT# <br /> i ature ate � � �O � _ � O� <br /> RcVI5E0 fl/I9Q0f� . <br />