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i <br />UTILITY PERMIT APPLiC�4TION <br />CITY OF EVERETT PERMIT SEF2VICES <br />3200 CEDAR STREET, EVERETT, WA 96201 <br />425-257=8810 - FAX 425-257-8857 — wuvw.everettw�.org <br />I,9,ZS v�rcl��9aL <br />PROJECT ADDRESS <br />C3�ej <br />Rd(u„%.xtP.� 19Z8 Wi.��oa�i 6U€�� w a. Y82a 1 �34 -vz,rz <br />Property Owner Mail Address Ciry State2ip PAone <br />Vl Q jQ �C' <br />Tenant Name (If this is for a commercial bi�siness) <br />(y 25� <br />� SS �.�oG Lae.l;h da �sv��� wa , Q��o3 z����ias9 <br />ConiraCtor Mail Address Cily StalrJZip Phone <br />Q Mk.�Z �..,� S�6 � K L <br />WA State Contrador License Number (reqwred) <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 />O lnstall Water Meter <br />REVISEO f I/fVI0I1 <br />h53 ��8 <br />City of Everett Business License Number (required) <br />FEE <br />3c�� <br />PERMIT# <br />u I���-pl5 <br />