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�— ---- --- - - -- — <br /> I UTILITY PERN9IT APFLICATIOf� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 —www.everettwa.org <br /> 15ii �7a��,��1/�� A�� <br /> PROJEC7 ADDRESS <br /> 13v nn �e. 5 ��iu.R is�i ro�!���/��.. ��er� ��' 2.o r <br /> Property Owner � Mail Address C�ry � Stale/Lp , Phone <br /> �� <br /> Tenant Name Qt this is for a commercial business) <br /> G,�►fr�lwl/�s 1"`vM�Y� �D l�ox Ssy/ �tic��e.,� -�'j,Qzo� �J��.�s�i-9 �3 I <br /> Comractor h ad Address Ciry SWIe2ip Phone <br /> I C'�M�r3��y 9�7��1s �o��x�� <br /> I� WA Sta�e �'ontraclor License Number(reqwred) Ciry oPEverett 6usiness License Number(required) <br /> iWork to be done: <br /> ❑ S.ide Sewer Repair ' <br /> � <br /> ❑ Side Sewer Alteration <br /> ❑ Side Sewer— New Insta��aiion . <br /> ; Install Backwater Valve (outside the building) <br /> I <br /> I <br /> I ❑ Cap off Sewer <br /> i <br /> � <br /> i . <br /> ❑ Install Water Meter FEE <br /> ��� <br /> ^ La�.,,� Ci !/"(S(/`"L/ PERMIT# �,y� <br /> -- Signature �3�e � I � �_I — � X � <br /> CJ C� <br /> I � � . . . . .. __. . . <br />