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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 /> � �i /� - �uG�l�'v �� <br /> PROJECT ADDRESS <br /> ,! , r <br /> �¢Gl1l�!/',/�CUP�G1` <br /> Propehy Ov+ner lda�l Adtlress C�ty State�Z�p Phone <br /> Tenan� Name(II Ihis is for a commercial business) <br /> �����1�/rNC1 .C`G ����/U6��'��a��� `�d�3� �r',2S y�11-m�15 <br /> CoNractor � Mad Atldmss Clty StatelZip Phone <br /> �1��LU�- �ai��'d ��`S� <br /> WA State Contractor License Num6er(required) City of EvereU Business Li;ense Number(required) <br /> Work to be done: <br /> ❑ Side Sewer Repair <br /> ❑ Side Sewer Alteration <br /> ❑ Side Sewer — New Installation <br /> instail Backwater Valve (outside the building) <br /> ❑ Cap off Sewer <br /> ❑ Install Water Meter FEE <br /> � � p0o <br /> ��,����nZ%�.��� ��^���S P[RMIT# <br /> S�gnalure ���� U `I�. O�� DI„� <br /> "./ lS1 <br /> REVISED�i/C.MIJ <br />