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� UTILITY PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, VVA 98201 <br /> 425-257-8810 - FAX 425-257-8857 —www.evereltwa.org <br /> �� ��� ��� �� <br /> PROJECT ADDRESS ��g�l �G16 <br /> 0'1 I�oci�) ��0� �5�2���' C, ��F `� yg�S <br /> Property OwnCr Mail Address Gry Sta 2ip Phone <br /> � <br /> Tenant ame(IF lhis is for a commerciai business) �Q/_ <br /> �bsdH.'f�y4c�M rU <br /> �a Se,� ��2,� �`�6�k �Sw �►�� W14 �8�� �� <br /> COnlractor MaJ ACdress Crty State2ip Phone <br /> ��S�I55 �.� \ ,-�i B� � ��'� <br /> WA State Contractor Licens umber(required) City of Everett Business License Number(required) <br /> Work to be done: <br /> ❑ Side Seti�er Repair <br /> ❑ Side Sewer Alteration <br /> ❑ Side Sewer— New Installation <br /> � Install Backwater Valve (outside the building) <br /> ❑ Cap off Sewer <br /> ❑ Install Water Meter <br /> FEE <br /> 3 D�° <br /> � � � � � "' ' ��� PERMIT� <br /> . naWm Date � � �O <br /> 3- I � <br /> FEVISFD f I/f 9/701 J <br />