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" � � UTILITY PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 42�257-8810 - FAX 425-257�857—www.everetlwa.org <br /> /sv 4 �?�1���-,� <br /> PRW ECT ADDRESS <br /> � fJ� - ��l �- `r'a2o 3 <br /> Propertyowner Maanmress cay smt�zm v�wne <br /> Terent Neme(If ihis is for a comrtierdal business) <br /> ,��t ,Q�vn-rlv�i�� LL C �6l/ l//1'�r�a�c- t� �c�iuT <br /> Contraclor dd�ess City StateflW Phone <br /> �,��v/,�oli�,� 4j7SS� <br /> WA �tate Contrador License Number(require� ' City of Everell Business License Number(requited) <br /> Work to be done: <br /> ❑ Side Sewer Repair <br /> ❑ Side Sewer Afteration <br /> ❑ Side Sewer— New Installa6on <br /> Instail Backwater Valve oulside the building) <br /> ❑ Cap ofi Sewer <br /> O Instail Water Meter <br /> FEE ^� <br /> ���-/ <br /> •` � PERMIT# <br /> Signature D U I�0 �J I �� <br /> �t�naz��� <br />