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� . . . <br /> UTILITY PERMIT APPLICATION <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 /> Jtiic� ,�2�.,�1«r — - — <br /> PROJECT ADDRESS <br /> �� fvfrv iPI�Y � J`-!lo I2�c�f' [-.dPVEt� � tJ� �125-35�'!'�26 <br /> Ptop2rt� MailAtldress Clly StalelZip Phooe <br /> Tenant Name(I(lhis is for a commercial business) <br /> �Pwr��' Fr� E' v�c� �v ��C; ��D �ac�x. ��-� � 5 L v � r� w��r��,P, wA 9�v ��� <br /> COnlfac�of Mail AOdr ss City SlalelZip pPnhone �1 �/ <br /> ZU�.D ` O 1 (J '7 17 D <br /> �c���-e r� F � �-1 ��.: ���S �'-! �7 7`14 <br /> WA State CoMreclor License Number(requiretlj Cdy of Everetl Business Licease Numher(required) <br /> Work to be done: <br /> ❑ Side Sewer Repair <br /> ❑ Side Sewer Alteration <br /> ❑ Side Sewer- New Installation <br /> f� Install Backwater Valve (outside the building) <br /> / <br /> ❑ Cap off Sewer <br /> ❑ Install Water Meter <br /> FEE <br /> �D <br /> ������� I .Z/�/ � �t PERMI'# <br /> Signature Oate U I �'2 _ n�2 <br /> V <br /> FENSED 1 f/19ROfd <br />