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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 /> ZI 2�1 �,v,-c�e.r 14U� , !.}a s� <br /> PROJEC ADDRESS ��n� <br /> M�Ke..-i'�lie, `a R�,Yc, ��/a' �v��� }/— � . � 3�-13 '✓��`�8 <br /> wn r 61ai1 Atldress C�ty ` Slate/Z�p Phone <br /> Pr O e <br /> ' "/� <br /> Te�l Name (II this is for commercial business) �Q6 ' <br /> � �r�� �-��� . .w, �a�no�c� �� o �80� b5' <br /> Coniraetor Mail Atldiess Cdy StalelZip Phone <br /> �Is� �`�'� °� 5 D51 �� <br /> WA State ConVaclor License N (nber(requiretl) Ciry ot EvereU Business License Number(required) <br /> v <br /> Work to be done: <br /> ❑ Side Sewer Repair <br /> ❑ Side Sewer Alteration <br /> ❑ Side Sewer — New Installation <br /> i Install Backwater Valve (outside the building} <br /> ❑ Cap off Sewer <br /> ❑ Install Water Meter <br /> FEE <br /> ��. � <br /> 5 �g��` � PERMCf� <br /> Sign� � Dale � I � <br /> 505 o�I Q� <br /> �eev�sc.9 ir,r,2oia __ � <br />