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UTILITY PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVER[TT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 —vnvw.evereltwa.org <br /> iyoz �����,yz- �� <br /> PROJECT ADDRESS <br /> C�-�c�e ;� I yoT �ei4,'� i�-��✓�.�-i t�-/� _ <br /> Property Owner ldae Atldiess Cny Staie/Zip Phone <br /> ,� �,+ <br /> Tenant Name Qf this is(or a commr.raal bus�ress) lJz� I/ ,qZ-7�� <br /> a <br /> ,�,�c�Z �eus�?��T�mn(>�L�,c�S 3a3 9i�h,r��� ��}�,�Gj,�'Jd,�15 W-�'�G�� <br /> CoNr2clor .^ad Adaress CAy State2m Pnone <br /> �pNcGS �B57JU-� # f�S�lO �l <br /> WA Stale Contraclor License Number(ieqmreA) Cily of[verett Business License Number(required) <br /> Work to be done: <br /> � ide Sewer Repair <br /> ❑ Side Sewer Alteration <br /> ❑ Side Sewer— New Installation <br /> �Install Backwater Valve (outside ihe building) <br /> ❑ Cap off Sewer <br /> Install Water Meter <br /> F[E <br /> 30� <br /> / Q� L�� rJl / 7 Z.9 �5` PERMIT# <br /> SignJlwC DatC � I �� � ' ���J <br /> � <br /> ,C':�SEO n�w¢JN <br />