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UTILITY PERMIY APPLICATION , <br /> CITY OF EVERETT PERMIT SERVICES <br /> 32d0 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257�810 - FAX 425-257-8857—www.evereHwa.org <br /> ��-I,l� QaKS <br /> ,PROJECT ADL)RESS • C�(�� <br /> ( l 5 �v� �S?.�cl � 3�G5 — �28� <br /> � 5 ��i5 � � St�te2ip Phone <br /> Property Owner �9ail Address �'ry <br /> i � <br /> Tenent Name(If this is tor a commercial business) <br /> � -7�— (�, (tizs) <br /> �_ � CJ� �IG��G'1 dR �V (G�1.1 l/J q —1��� �4 Pho�C{ 'J�� <br /> Contractor <br /> Meil AdA��ess City Stala2ip <br /> /� Ntk.�i�� �6 L K � �73 ���{8 <br /> N1A Stale Contractor Lfcense Number(required) City of Everett Business�cense Number(require� <br /> Work to be done: <br /> ❑ Side Sewer Repair <br /> ❑ Side Sewer Alteration <br /> ❑ Side Sewer— New Installation <br /> E7 Install Backwater Valve outside the building) <br /> ❑ Cap off Sewer <br /> ❑ Install Water Meter FEE � <br /> �v v <br /> � <br /> , <br /> G,�2�" ���� PERMCf# <br /> s�g aa <br /> — Date U �GjD Z " l D �P <br /> pEWSF.O 11dIROfO -- <br />