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� UTILITY PERMIT APPLICATION <br /> i CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAP. STREET, [VL=RETT, Wn 98201 <br /> � 425-257-8810 - FAX425-257-8857—www.everettwa.org <br /> � 1�. S�'(�l�c �� <br /> PROJECT ADDRESS ' <br /> �d�e 2 ��s�-dY' f,ron � yZ;_Z(�� Z4y <br /> Property Cwner Mau aadress Cdy S�aiaZ�p anone <br /> I <br /> II <br /> I Tenant Name Qf lhls is for a tommercial Dusmess) <br /> I GS o3 gl s� �NC �Soz 5�3 �l+�b Sr�J�r�S G9-�'�— C1�Z� <br /> Coniractor '.taiiAddress Gry StateZp Phone <br /> �or�zGS 9D5 �l�J � 5010� � <br /> WA Sfate Contractor License Yumber irequired) Cdy of Everett Busmess License Number(reqwred) <br /> Work to be dane: <br /> rJ Side Sewer Repair <br /> ❑ Side Sewer Alleration <br /> ❑ Side Sewer — New installation <br /> C�' Inslall Backwater Valve outside Ihe building) <br /> ❑ Cap otf Sewer ' <br /> ❑ Install Water Meter <br /> FEE <br /> !� <br /> ��b.Q= <br /> - � �Z� ��> PERMIT?t <br /> , S�gnature Date U I�O,J^ I�� <br /> anrsen nn?co„ <br /> �— — <br />