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UTILITY PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STR[ET, EVEP.ETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 —www.evereitwa.org <br /> ��C� b ��U�-�Y� �V2 <br /> PROJECT ADDRESS �o�S���`7I�� <br /> �/G S �e� ��eS- �b C3�x �l� �� � ��� �u �&�7S <br /> Property Ow er Mar�Add�ess City State/Z�p Phone <br /> Tenant Name(I(this is for a commerual b�siness) <br /> a�6 - <br /> �utt-I� �,� ��,�« 18�c� ���-*s .��-rl-I� ��Slv � 6 3a-�v�y <br /> CON�ac�or M1tad Address City State2ip Phone <br /> SEAT► � � 91� Ci� �� 14� <br /> WA State Conlractor License Number(required) Cny of Everett 9usiness License Number(requlred) <br /> Work to be done: <br /> ❑ Side Sewer Repair <br /> ❑ SideSewerAite�ation <br /> ❑ Side Sewer — New Installation <br /> �--Install Backwater Valve (outside the building) <br /> ❑ Cap off Sewer <br /> ❑ Insiall Water Meter <br /> FEE <br /> 3ooO <br /> (C o�rl��`u"' /I 3� av/�' PERhiCf� <br /> ` Si ature Dale � I r 0�— ,�^ r\ <br /> '� lN✓ <br /> P[Vi5F01 v�9^0�: <br />