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� UTILITY PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CFDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 —www.evereltwa.org <br /> �.31(' _' r�UG/��i/�(�� <br /> PROJECT ADDRESS <br /> 57�tGi�m�� �i/��i� <br /> Property Owner M ii Address City State2ip Phone <br /> Tenanl Name pf�his is for a commercial busmess) <br /> %/f�lLi�'�N�/�� � ��//-l���Ga�.r��� 9'��a�' %.s'v�Y��z3 <br /> Coniractor hlad�ddress Cny StatelLp Phone <br /> �ff-/�L U/��«�d.� d 5'7.��� <br /> WA State CoNractor License Number(required) City o(Everel�Business License Number(required) <br /> Work to be done: <br /> O Side Sewer Repair <br /> ❑ Side Sewer Alteration <br /> ❑ Side Sewer — New Installation <br /> �'Instali Backwater Valve (outside the building) <br /> O Cap off Sewer <br /> ❑ Install Water Meter <br /> FEE <br /> ��O e�/ <br /> � ���%T/v � �����`�� PERIIIT# <br /> SignaWre Date � �r^�� ( � ��, ( <br /> -� �—� �_P <br /> I <br /> FEVi5F0�in4'201a <br />