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� _ _ . _ _ _ ____ _ _ _ _ _ _ - _ _ _ __ _ __ _ _ _ _ _ _ _ _ _ , <br /> �. � <br />� � UTILITY PERMIT APPLICATION ; <br /> � CITY OF EVERETT PERMIT SERVICES � <br /> � 3200 CEDAR STREET, EVERETT, WA 58201 I <br /> I 425-257-8810 - FAX 425-257-8857 - v�nvw.everett�va.org <br /> r I <br /> ✓' �I I /�[JC/( C/ C.lI�'!' _ � <br /> PROJECT ADDRESS I <br /> �) /– n <br /> Yn .✓ ��zl' ��' S� , C r/G.- av�'— w� l•Q � <br /> Cd Stale/Zip Phonc • <br /> ' PrapertyOwnCf I.taAAddress Y . ' <br /> I <br /> i ` <br /> Tenant Name Qt tY,�s is`or a commerc�al business) . � <br /> I � <br /> i �q���'_1L�1 I �ir1�«(��}�' �{-'� SrJ�f � �v�v'c,Tl l.�.J� I�S� i <br /> � Con'ractor <br /> !,ta;l ACd�ess ,/ Gry State�Lp P�one <br /> � <br /> � �Nl r'� +� ��� �� Nl_S —���a� <br /> � �;Ji1 State Conlracror�icense Number(requued) City of Everetl Husmess license Number(required) � <br /> i <br /> � Work to be done: I <br /> � ❑ Side Sewer Repair <br /> I <br /> ' ❑ Side Sewer Alteration <br /> ; i <br /> I <br /> ❑ Side Sewer - Ne�v Installation I <br /> I ��Install Backwater Valve (outside the building) ' <br /> I I <br /> � <br /> i ❑ Cap ofi Sewer I <br /> � <br /> I ❑ Install Water Meter --—— ' i <br /> FE-E <br /> � = � ��� � �� <br /> I n� � j��___ �/�S�/r PERh1IT�/ --=—� I <br /> ��V /M�.� � �U � �b`�-1,�.� � <br /> ' Signafure Da1e <br /> II �- <br /> � <br /> � ���.���. .,�-... . . . _.� <br />