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r' - — --�� <br /> UTILITY PERMIT' APPLICATION . <br /> ClTY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERET�, WA 9820�i <br /> 425-257-8810 - FAX 425-257-8857—ww�v.everettwa.org <br /> 7 ll� �o�.ke� P LL� <br /> PROJECT ADDRESS ��ZS� <br /> � 1'��� Ztl ' .�r�e L � ? — SJ�y <br /> Propertyb�vner <br /> Mail ddmss City $tatelZip Phone <br /> � l�( <br /> Tenant Name(If this is for a commercial business) <br /> (�i ZS) <br /> � �� �,�� C y �17� d� C�1w�-►i wa �t��o3 �.��.--�i<<s� <br /> � <br /> ��, SlalefZip Phone <br /> ConifaCtor MailPidress <br /> a r�t�- �� S� �� � K �. ��3 °��(8 <br /> WA State Contractor License Number(required) City of Everett Business License Number(required) <br /> Work to be done: <br /> ❑ Side Sewer Repair <br /> ❑ Side Sewer Alteration <br /> � Side Sewer— New Installation � <br /> E�7 Install Backwater Valve outside the building) <br /> ❑ Cap off Sewer <br /> ❑ Install Water Meter FEE <br /> � �o• °� <br /> , PERMIT# <br /> Sig at Dale ' I I �Q � ��'�Z <br /> v <br /> aev�sen unarzo�a .- <br />