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UTILITY PERMIT APPLIC:�: �� duN . <br /> CITY OF EVERETT PE��"i'T SERViCES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257=8810 - FAX 425-257-8857—wvuw.sverettwa.org <br /> ���5 �a��-�� �I� <br /> PROJECT ADDRESS G42S7 <br /> „,�;tt t�o� � e Q ,�(1�I��.cl�. 77� - 0 3 <br /> T�(}.V�nnPfj�Pl N, CiFj State2p Phono <br /> Property0wner MailAddress <br /> in�� � <br /> Tenant Name(If this is for a commerual business) <br /> (�I ZS� <br /> � �,�t��;el+i� cda �U�`�-►;I W a �t��0� �.4�-i.--�t��sG <br /> COnifaCtOf MailAddress <br /> Ciy State?.ip Phono <br /> h� `�> `7C� - <br /> � iflk.�i SS �� � K � -�- <br /> WA 3tale Contractor License Number(required) City oi Everett Business License Number(reqwred) <br /> Work to be done: <br /> ❑ Side Sewer Repair <br /> ❑ Side Sewer Alteration <br /> ❑ Side Sewer- New Installation <br /> C�l" Install Backwater Valve outside the building) <br /> ❑ Cap oif Sewer <br /> ❑ Install Water Meter FEE <br /> � . (Q - (� ���� �i <br /> — ���S'cia✓.v �`Clyl PERMLTlt <br /> _ "— Dato � I ✓OIV�o 1� <br /> Sig at <br /> REWSED 11IIBq010 __---- <br />