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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 /> a� �s �, 4 �- �.,��� <br /> PROJECT ADDRES <br /> l onn y /"l�,:�u U�n ' a(o!J S r�/Ir�i�" r%Vr.rc� �-�' S c�3 �l"t6 `-F�t 3„� <br /> Property Owner Mail Address City Slate/Zip Phone <br /> Tenant Name Qf this is for a commercial business) <br /> MoF� vi�'�, ��si �S� sc sY,o�,�,�,�t�, w9- ��z4� kas�c� ���� <br /> CoMraClor Mail Address City State2�p Phone <br /> MoG�d nv �uF1310 o� 363s <br /> WA State Contr-.tor License Number(required) City of Everett Business license Number(required) <br /> 1A'ork to be done: <br /> ❑ Siue Sewer Repair <br /> ❑ Side Sewer Alteration <br /> ❑ Side Sewer — New Installation <br /> f� Install Backwater Valve (outside the building) <br /> ❑ Cap off Sewer <br /> ❑ Install Water Meter FEE <br /> 3D �� <br /> `� � . � I Z '�— ( � PERMCf# <br /> Signatuie Date � I� � �' h�(�, <br /> V � <br /> FEVISED Nls/to�d <br />