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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 /> 1�cS �Lvr ck�s- /fvP <br /> PROJECT ADDRESS <br /> �u L ,� n D er S� .4 �i/zs)3iP-6S67 <br /> Property Owner IAad Adaress C�ry State2lp Phone <br /> Tenanl Name pl this is for a commercial business) <br /> !�e eL �/uird �. 5 �/G7 7/j'1q•�,�LC r���v�•i� L�A'9Bt.xi �L/'�....57 3S�- ��7 <br /> � <br /> Conlraclor Ma�l Address Clty State2ip Phone <br /> /�Pc//PL 5�3GT GS3�/.lS <br /> WA Stale Contrac�or License Number(required) City of Everett�usiness License Number(reqwrud) <br /> i <br /> Work to be done: <br /> ❑ Side Sewer Repair <br /> ❑ Side Sewer Alteration <br /> ❑ Side Sewer - New Installation <br /> �Install Backwater Valve (outside the building) <br /> ❑ Cap off Sewer <br /> ❑ Install Water Meter FEE <br /> � � ob <br /> i <br /> _- I��Z� I,j� PERMIT# <br /> Signaturc Date � � J D r �0�� <br /> ��f l <br /> ne�nseoivia:vi+ <br />