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- ---- - - ----- - - 1 <br /> • ; <br /> UTILITY PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> i3200 CEDAR STR[ET, GVERETT, WA 98201 � <br /> 425-257-8810 - FAX 425-257-8857 -v,�ww everettwa.org <br /> � <br /> I <br /> Z /GZ lG���S _ <br /> PROJECT ADDRESS <br /> 1�u�s/ /3�rn/�ai 7' <br /> Property Owner t.ta�.i Adaress Cdy State2�p Phone <br /> I Tenant Name (If lhls is for a commerual business) <br /> I <br /> /-���/o {�/knD�ny S i/�7 7/���G�r .,-+<.�yS✓:,-G t✓A' %�'7G 3�S'J�iS�7 <br /> I Contrador t.ta�lAddress G!y Sta'e/Z�p Phone <br /> � AP// f�G �' ,�GT os3yss , <br /> �VA State Contrector L�cense Number(required) Cdy of Evzrett Business License\umber(reqwred) I <br /> � Work to be done: <br /> I I <br /> � ❑ Side Sewer Repair I <br /> j <br /> I <br /> � <br /> ; O Side Sewer Alteralion I <br /> I <br /> ' ❑ Side Sewer - New Installation <br /> i <br /> i <br /> �Install Backwater Valve (outsicie tf�e building) <br /> � <br /> I ❑ Cap ofi Sewer <br /> I <br /> � ❑ Install Water Meter <br /> FEE <br /> � �� <br /> i <br /> i <br /> I --.. . 3�//��,� PERMCT# <br /> S�gnature �ate � i� /'�� O�� <br /> I V <br /> �I n-u5E0 tr:t,^.2ra I <br /> t— —'___—______.____._—_—___--_____ ____— ___ <br />