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. ' <br /> UTILITY PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES � <br /> 3200 CFDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX. 425-257-8857 -u�nw+.everettwa.org <br /> � <br /> �,.�'. �f// }'%/��� <br /> PROJECT ADDRESS <br /> Property Owner tAad Atldress Gly Stale/Z�p P�one <br /> �w15 K�,�p�s <br /> Tenant Name (If this is for a commercial business) <br /> /Tl�G//fi ��Ls/�/3i �y C��,G� 7/�Avu ,✓r' i`�i�J�YSV///c�.__Jr✓� �57�7�i ��5� /SG7 <br /> COnif2C�Or �da��Atldress Cdy SlatelLp Phone � <br /> � /��.,GG��G�3G� - - � �i S.f <br /> WA State Coniraclor License Number(requi�etl) City of Everelt Dusiness License Number(required) <br /> Work to be done: <br /> � <br /> i� ❑ Side Sewer Repair <br /> j ❑ Side Sewer Alteration � <br /> i <br /> I <br /> ❑ Side Sewer - New Installation I <br /> � <br /> ,� Install Backwater Valve (outside the building) i <br /> � <br /> O Cap off Sewer I <br /> ❑ Install Water_Meter <br /> �--� FEE <br /> / /�� ��U� <br /> / �__... <br /> �C �,� P[Rh1ff� <br /> S�gnature Datc � I �� l � O ( �7 <br /> f ��� <br /> REvbEDfln9?OtJ � � � � <br />