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Sep 07 2015 08:35PM CJ'S PtUMBING 8 SEAVICE 360691-1301 page 1 <br /> ,-� '�ee�.fi ��.-�-!C�?_�!�-k _--- — <br /> UTILITY PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETf, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 — wmv.everetlwa.org <br /> o�l 3 I � !� �- <br /> PROJECT ADDRESS <br /> � �r � ►'l r m �hu ��l (�� � �-� ��e�.�l ,w►�- <br /> Property Cwnar Mad Adcn Ciry Ste 2io PEone <br /> ( <br /> Tonant Nemc (If this �s`or a commercial business; <br /> i ('.� �� Pl c,�r.�c•p�,r�, �, c � c SS -��S�t-, 141.��,� �r��t.�{�(�� 4�+� <br /> ConlraClor da!IA�tlrees Cir� Sta;o2ip Phone <br /> � C55 PL � s �� �s o� � �t��'�� <br /> , <br /> WA Stato ConlraUor llcense�'umbor(reqWrec) Ciry of Evorott Business Llcense Vum6nr(reqWred) <br /> Work to be done: <br /> ❑ Slde Sewer Repair <br /> I ❑ Side Sewer Alteration <br /> I <br /> ❑ Side Sewer— New Inslaliation <br /> I �Install Backwater Valve outside the building} <br /> 0 Cap off Sewer <br /> ❑ Install VVater Meter FEE I <br /> ��,�°� <br /> � � � PERMIT# <br /> S�gneturo oa�e � I,` y��� O'� /1 <br /> � �l- � !�(J <br /> IR;N9ED�v�¢�of� -_ <br />