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( ___ ___ ___ _ ______ _____ <br /> I UTILITY PERMIT APPLICATION <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 /> 2�Z� �oC,�,/��%/c.2 �vc� �l/WL�•7r az4 <br /> PROJECT ADDRESS �yz ��� <br /> S'�cv �,i�14��1 'LI24 r�iC�c=� ��w� �.v�yz�;r w�- . 4�- 2sF� `fo2c: <br /> Property Owner �dad Address Cily Slate2ip Phone <br /> Tenant Name(If Ihis is(or a commercial business) <br /> l-�-i.vu� PL,:.,�gi rJ� Sr�o 1�4 cvti�si-� w�. 2, 6_�fc 6.- a'9 y i <br /> Contractor Mail AdCress Cily State2�p Phone <br /> , �}urwPrc8G3�s dS 3s3s <br /> i WA State Contractor License Number(required) City of Ecerelt Business License Number(required) <br /> I <br /> I <br /> IWork to be done: <br /> I ❑ Side Sewer Repair <br /> i <br /> i <br /> ❑ Side Sewer Alteration <br /> ❑ Side Sewer — New Installation <br /> I <br /> i �Install Backwater Valve (outside the building) <br /> I <br /> i <br /> � ❑ Cap off Sewer <br /> ❑ Install Water Meter <br /> FEE <br /> �D ��o <br /> c\�� ��2 - 3/ — I� PERMIT# 1— � <br /> SignaWre Date ' 1 I (I /�— I�� <br /> U T� l <br /> FEVISFD lviv^.Ou <br />