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� UTILITY PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 -www.everettvra org <br /> t i t � Pn-c�F� c ��r L.-v�-�-r- 9� 2 a ( <br /> PROJECT ADDRESS <br /> C/o ��crC S� a� M pa� Rc��-,r�-' 91�=5'4+- 22ss <br /> Property Owner h7al AdCress �'ly State2ip Phone <br /> Tenant Name (If this is(or a commerc�al business) <br /> � <br /> ��i ��.�,.:�• Po c�ok SS"1 SNo� w�* . 5'S 2 Pi � <br /> � Conl�aGtor t.lail Adtlress Cdy State/Lp Phone <br /> �{��P�t.-�f�3N1 �S'3'3 3 � <br /> 1NA Slate Contractor License Number(requued) City o(Everett Business License Number(required) <br /> Work to be done: <br /> ❑ Side Sewer Repair I <br /> � <br /> i <br /> ❑ Side Sewer Alteration <br /> ❑ Side Sewer - New Installation <br /> Install Backwater Valve (outside the building) <br /> � <br /> ❑ Cap off Sewer <br /> ❑ Instali Water Meter — - <br /> FEE <br /> � v� <br /> a f <br /> _ �/ ( r/�S� pERMif# //''�� <br /> Signatu c \ Uatc 1 � I �/�U � �a� <br /> V �/O <br /> ,:�,ns[o„n�,^�,< <br />