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�% _ <br /> UTILITY PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAF STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 475-257-8857 -www.everettwa.org <br /> � S��^ C�Y��L� S <br /> PROJECT ADDRESS <br /> ' .�����v'J,'�o-k-1 •l S l3 O►4ksF�-`rc.� ( �r� � <br /> Property Owner 1.tad Addiess Cdy Slate/Lp Phone II <br /> Tenant Name Qf this �s(or a commercial business) <br /> ��S �lvw�bw, SSZS- 21 d' �l.��q�-'L A.f �iwa��iT�'�ls Lvl9 /c.07.� �6oldr/S/S <br /> —a— <br /> CoNractO� t an Adtlress Gty Slate/Lp Phone <br /> C� sP�SS lSoa� c���So"l <br /> WA S Contrector Llcense Number(required) Gty o(Everetl Dusiness L�cense Number(requiretl) <br /> Work to be done: <br /> ❑ Side Sewer Repair <br /> � <br /> I ❑ Side Sewer �Iteration <br /> ❑ Side Sewer - New Installation <br /> �71 Instail Backwater Valve (outside the building) <br /> 1 ' <br /> ❑ Cap off Sewer <br /> ❑ Install Water Meter <br /> FEE <br /> 2 O�� <br /> � <br /> PERMIT� <br /> 5�9����re ��ie U 1503 — bo <br /> PEwSED t In9?Ola <br />