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' -- --- -- - � <br /> �-- -- ------ <br /> UTILITY PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STRE6T, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 -www.e�•erettwa.org <br /> 234Z. ��� N� S?c�t' C—v��'�" U'� <br /> PROJECT ADDRESS <br /> �e i cr s�l,N�c�� <br /> Property Ovrner tdail Address City Stale�Zip Phone <br /> fJ0 J <br /> Tenanl Name (IF this is for a commercial business) <br /> SS73 <br /> N W S��� �� 1'� �x 5�� <br /> CoNtacior t.fa�lAddress Cly State/Zip Phone <br /> nJU1S��5� ��3 P r� �53�( $2 <br /> WA Slate Contraclor Lirnnse Number(required) City of Everetl Business Liwnse Number(requi�ed) <br /> I <br /> Work to be done: <br /> ❑ Side Sewer Repair <br /> �Side Sewer Alteration <br /> ❑ Side Sewer- New Installation <br /> � Install Backwater Valve (outside the building) <br /> ❑ Cap off Sewer <br /> ❑ Insl I Water Meter <br /> fEE <br /> �� o� <br /> � '( l � / � PERr•�rrx <br /> ignature Date I ' ��D l � O�Q� <br /> �� G o <br /> PE155ED Ir/�9401i <br />