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� � • _ — -- — <br />, � <br /> J �1TILITY PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> . • 425-257-8810 - FAX 425-257-8857 –ww�,v.everettwa.org <br /> � <br /> �7 � ��l I�D��P�����i"�vc <br /> PROJECTADDRESS <br /> r �^ � <br /> �I/1�� � L] _C�`Jyl�. —. <br /> � Property Owner tdail Address Gty State�Z��p Phonc <br /> I <br /> Tenant Name (If this is for a commercial business) � <br /> .�_��� � u rh �v� �p. 5'S� � - v�.rc I,� �8 � <br /> � Confractor Ma�l Address C�ty State�T.ip Phone <br /> C'�tMr'�� 1�1 �� MS oy -r � o3 . <br /> W�Slate Contractor License Number(required) Ciry of Everett 6usiness License Number(requued) <br /> Work to be done: <br /> O Side Sewer Repair <br /> I ❑ Side Sewer Alteration <br /> ❑ Side Sewer – New Installation <br /> � Instali Backwater Valve (outside the building) <br /> � Cap off Sewer • <br /> ❑ Install Water Meter FEE <br /> . �3D.Q° <br /> I /f�il /,_,'_ _,� ,�, PERMIT# n <br /> J !/ S�gna�,--- Date V l�U� ' V I v ' <br /> on,acn rv�onme . . _ .�_ . � '_ _._ <br />