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UTILITY PERMIT APPLICATION <br /> CITY OF EVERETT P�RMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8610 - FAX 425-257-8857 —www.everettwa.org <br /> �,���N�P <br /> PROJECT ADDRESS <br /> Kl�,rr � I�r� �J3�/"NL'��J=��AJ '7� �/�G` / O ZO/ <br /> P�operty Ownet htad Address Gry SlalelZip Phone <br /> Tenanl Name Qf Ihis is for a commercial business) <br /> CQ�wn�d/IC ///AMh�A� _ <br /> CoNractor Mail Addres Cny SWte/Zip Phone <br /> C�4►^i� 3�z 9�� r�S � 04�703 <br /> WA Stale Contractor license Number(required) City of Everetl Business License Number(required) <br /> Work to be done: <br /> ❑ Side Sewer Repair <br /> ❑ Side Sewer Alteration <br /> ❑ Side Sewer — New Installation <br /> Q Install Backwater Vaive (outside the building) <br /> ❑ Cap off Sewer <br /> ❑ Install Water Meter FEE <br /> �0�� <br /> �/�,/�jJ���� PERMfi# <br /> —T " Signature ��1e I I I f�(1� � Q 7�{ <br /> v -J v � � <br /> aeva�o i+ns:a++ _ <br />