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llTILITY P_ERMIT APPLICA�ION <br />CITY OF EVERETT PERMIT SERVlCES <br />3200 CEDAR STREET, EVEREI7, WA 98201 <br />425-257=8810 - FAX 425-257-8857 — www.everettwa.org <br />���,� 2. �t o 9 2��� ��t f,�./ <br />PROJECT ADDRESS <br />S 4�t�. � tf v tj i! �ck��C' <<?✓ �v-cn.�'� �/�}- `�7�L �� �l2 �" 3� 7S 5/ <br />PropeRyOwne� MailAddress Ciry StalelLip � � Phone <br />Tenant Name (If this is for a commercial business) <br />�r��, <br />Contractor <br />i�s�s y,tr <br />Address <br />moenP(��:- FsS�35o <br />WA Sfate Contrador License Number (required) <br />Work to be done: <br />❑ Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer — New Installation <br />��ti�-.,�s�. wl� <br />Ciry � Stale2ip <br />� Install Backwater Valve (outside the building) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />, <br />� �--- <br />Signa urc . � • <br />RF.VISE011/19/1014 <br />',2 S 7toc� <br />Phone <br />OS'�63 S <br />City af Everett Business License Number (required) <br />�-P —j o -r s� <br />ree <br />�30 .�° <br />rERMrrr� <br />u � 50�- �5y <br />