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UTILITY PERMIT APPLICATION <br /> CITY OF EVERET7 PERMIT SERVICES <br /> 3200 CEp��R STREET, EVERETT, WA 98201 i <br /> 425-257-8810 - FAX 425-257-8857 -www.everetiwa.org <br /> � <br /> � y � ) �P�9J� S'�• <br /> I PROJECT ADDRESS <br /> � <br /> _�J `��� �--� L- C_ S� /-�7 r-�, � <br /> � <br /> Property Owne� �dai�Address City Slate2�p Pnone <br /> Tenant Name (If this is for a commercial business) ?�(� <br /> C�.t=GZPN.S OJJ� LL C � .G � � G �C S SS�� Gi31 7� <br /> �JT a7 /1����/2��z � bGZ H.Zi7� S 1-�aR� G��tIC� G✓� �J�'/J5,5 <br /> Coniractor �+'�adAtldress Cdy State.'Zip Phone <br /> �l/G✓5.��/S u �;� � i�� ���� Z <br /> VJA State Contractor�icense Number(reqwred) City of Everett Busmess License Number(required) <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 /> ❑ Install Water Meter <br /> FE[ <br /> 3 �oo <br /> � - Z ��' PERMrT��� f <br /> Signalure �1e I 1 � [ ( V1 _ I ?� � <br /> lJ J� l <br /> RFVISEO+fn9.?01a <br />