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' �� Z <br /> UTILITY PERMIT APPLICATION GG'k`s <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STRE[T, [VERETT, WA 98201 <br /> 425-257-8810 - FAX 425-?57-8857 -�w,nv.everethva.org <br /> � �.5/7 M�,/e <br /> PROJECT ADDRESS <br /> �T�L�d� <br /> Property Owner P.7aii Address C��y State2ip Phone <br /> Tenant Name (If th�s is(or a commercial business) <br /> �J p I <br /> /�/�G/�G �/(ti/J/3� n4 fClt.'7 �/Sj�vGNr �✓J�ly�//i/G �t/�"l��'�'/ 3fi7 /So7 I <br /> Con,rador daiAddress C�ty StaterZ�p Phone � <br /> /�P�,GLPL 9c�3LT Gs3 �iss <br /> WA Stale CoNractor License Num6er(reqwred) Gty ot Everett Business License Numher(required) <br /> Work to be done: <br /> � Side Sewer Repair <br /> � Side Sewer Alteration <br /> ❑ Side Se�ver - New Installation <br /> (5�nstall Backwater Valve (outside tlie building) <br /> ❑ Cap off Sewer <br /> ❑ Install Waler Meter <br /> F[[ <br /> j O�° <br /> � V - _ . .3�// �/� PERMIT# <br /> Signalure Date � I � O� _ /�� <br /> U <br /> RFVISED tl/19ROta � <br /> I <br />