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UTILITY PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVIGES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> - 425-257-8610 - FAX 425-257-8857 -www.everettwa.org <br /> � <br /> /,S�/� � �/CL'ci� <br /> PROJECT ADDRESS <br /> /r10 d�� r Jo��.� s�� s�/,� ��c��P ` u-.� <br /> PtopCAy Owner . Mail Address � Cily State2p Phone <br /> Tenanl Name Qf this is for a commercial business) � - <br /> ���1� I �� t��'a. ss�r �,�.�,-�.�-1 �� ��s� <br /> Idail Address City State2ip . Pnone <br /> Contractor . � <br /> �'�rl �� � ���.7 M S O �-1 � '1 O 3 , <br /> WA State Contractor License Number(required) Citybf Everett Business License Number(required) <br /> Work to be done:. � <br /> � Side Sewer Repair <br /> ❑ Side Sewer Alteration <br /> ❑ Side Sewer- New Installation „ <br /> ,,;. <br /> "�:� ':,. <br /> �Install [3ackwater Valve (outside the building) <br /> , . .. <br /> ❑ Cap off Sewer - <br /> ❑ Irostall Water Meter � <br /> FEE <br /> . . �'��.� <br /> � YiGr� ���� '3/0���— PERMIT#' r ' <br /> .. . Siqnawr� : . � � oate .. . V �� �:�.�1-1 � � , <br /> o����«�.�,�o���,� . . . ... . . . . . <br />