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UTILITY PERMIT APPL�CATION . <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 /> 1,7.08 Q,vc_,��t'L <br /> PROJECT ADDRESS � ��Z�� <br /> V rza tzc� vcl��+2 r���- wc� , 35Y — �� � f <br /> Ptoperty nef MailAddress City StateZp Phane <br /> i � <br /> Tenant Name(If this is for a wmmercial business) <br /> C�i zS) <br /> � �� �.�uC .i�r��a� c�R C1lw2r—ll Lv0. ���03 .Ztiti�-9��54 <br /> ColllfaCtof MaiIAECress <br /> Cm, SlatelZP P�one <br /> /-! M�.P.i 55 �� f, K L. n�3 ���l8 <br /> WA State Contractor License Numher(required) City of Everett Business License Number(reqwre� <br /> Work to be done: <br /> ❑ Side Sewer Repair <br /> ❑ Side Sewer Alteration <br /> ❑ Side Sewer— New Installation <br /> ET Install Backwater Valve outside the building� <br /> f' Cap off Sewer <br /> �7 Install Water Meter FEE <br /> � 30, bo <br /> — — Z[� — �S PERMIT# <br /> Dale � l I_ /1�-'l — Il� � <br /> Sig at J �f � v <br /> pEvrseo nnvtma . <br />