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. <br /> UTILITY PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> � 425-257-8610 - FAX 425-257-8857—www.everettwa.org <br /> ,�-,�i !J `�'LcuR-ec_ �u7— <br /> PROJECT ADDRESS <br /> 2� �-'78`— o�S7 <br /> `-rn2t l�u�;,��d 2�-ri /na-P-�- sT E��- � 9�D 3 <br /> Properfy Owner Mail Address City StatrJZip Phone <br /> Tenant Name(If this is for a commerdal business) <br /> , . � ��2li li/Ji o�rcLnA.� � /y�.r_ <br /> � �. <br /> ��.t.�7. �n�/���fl/�.�5 �� f-irz,— c�A- `7'P2o3 �89-o/z3 <br /> Conlrador Mail Address City StalefZip Phone <br /> ��ai., /�c�i �A - ��7S,SG <br /> WA Shate Contractor License Number(required) Cily of Everett Business License Number(required) <br /> Work to be done: <br /> ❑ Side Sewer Repair <br /> D Side Sewer Alteration <br /> O Side Sewer- New Installation <br /> stall Backwater Valve outside the building) <br /> ❑ Cap off Sewer <br /> ❑ Instail Water Meter <br /> FEE <br /> .3�0� <br /> I— O - l S PERMIT# <br /> Sgnature . Date � I � O � _ ��� <br /> � aenseo�inv�oi� � . <br />