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UTILITY PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - �AX 425-257-8857 —www.everettwa.org <br /> � <br /> /52� Qxc� �v� E.� �r � f�- <br /> PROJECT ADDRESS <br /> '— Sct�nc� <br /> �P�c�n `'L-�e,r �� <br /> Property Ownef Mad Address Gty Slatc2�p Phone <br /> Tenant Name(II lhis is for a commercial business) <br /> �'a�ob�t�s QI �� �,��� �o ss�ri E,�-��-I �� ��w� . <br /> CoNraclor , �dail Aatlress City Slatc�Z�p • Phone <br /> CAM ��� I�J� MS °�� o <br /> VVA State �ontractor License Number(required) Ci�y of Everett Business License Number(required) <br /> Work to be done: <br /> ❑ Side Sewer Repair • <br /> ❑ Side Sewer Alteration <br /> ❑ Side Sewer— New Inslallation <br /> Instali Backwater Valve (outside the building) � <br /> ❑ Cap off Sewer <br /> ❑ Install Water Meter FEE <br /> � ?�,�'% <br /> " S �� I rj 2U/5 PERNITk <br /> � Signalure . ale � I'I �/, � _ O �/ <br /> �,J � U tl� <br /> ocncrn��noo.me . . . . . . _ __. _. . <br />