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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 —wnvw.everettwa.org <br /> ��5�3 2� 12-�-c�Le.�� ��— <br /> PROJECT ADDRESS <br /> —���-iY�1'n1� ,�� 2 �3Z � . a� � -- � s�-�o <br /> Property Owner Mail Adtl ess Cdy StatelZip Phone <br /> Tenanl Name (II this is for a commercial business) <br /> �z S�� <br /> -�=P-�'"—(o �LC �r,,r (,�f+- `�a'Z-Ud' �-/� �-o�2-� <br /> CoMractor Mail Adtl c s Gly Stalc/Zip Phonc <br /> �U/l.f�l� ��/ !/ 1 ( �� Y <br /> WA Slal Conl actor license Number(requned) Cily of Everetl Dusiness License Number(required) <br /> Work to be done: <br /> ❑ Side Sewer Repair <br /> ❑ Side Sewer Alteration <br /> O Side Sewer — New Installation <br /> Q�stall Backwater Valve (outside the building) <br /> ❑ Cap off 5ewer <br /> ❑ Install Water Meter - - <br /> FEE <br /> � �0. �° <br /> --- (, _I�l�_ PERMITt1 <br /> S�gnaNrc Date 1 I Iif�/�_ (.�� <br /> U �q /.e A 1 f <br /> ,/ Mi' �� <br /> Ia-v6r�D�vrn:nb� - '------- - -- --------�— ------ --- - - .._--- - --- I <br />