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r---- -- --- - <br /> . ' <br /> UTILITY PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CGDAR STREET, EVERETf, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 —www.everettwa.org <br /> � 16 �ti Ylp�z-e�el��,. 6�-e-- <br /> PROJECT ADDRESS <br /> _�� yZS Z y� l7�'� <br /> Propedy0emer h9ailAddmss City Sfale/Zip Phone <br /> TenaN Name (If lhis is for a cnmmercial business) <br /> �/��e,((I�P�S� Cr',ns'f�u�7�'�rn I�,�e p0 �X l�f i( �'/�ai?%o2, l�1 iP2�1- - <br /> Conlrador Moil Atldress City Stale/Zip Phone <br /> wF� ����CL���1 /,I�/t D ;Z`t �;8 <br /> WA Stale Contractor License Number(required) Cily of Everetl Business License Number(requireu) <br /> Work to be done: <br /> � Side Sewer Repair <br /> ❑ Side Sew�� Alteration <br /> ❑ Side Sewer — New Installation <br /> �' Install f3ackwater Valve (outside the building) <br /> ❑ Cap off Sewer <br /> ❑ Install Water Meter <br /> FEF. <br /> �� L- r � 3 � � �----- <br /> C' " � � ID IS PERMII J! <br /> � ----- <br /> --�� �g aturc ---- -- —�- Datc <br /> UIS03 - O � i <br /> ,_��,��,�,,,,��„ <br />