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�--' -- - <br /> � , — <br /> I <br />� I UTILITY PERMIT APPLICATIOfV <br /> i CITY OF EVERETT PERMIT SER�ICES <br /> ' 3200 CEDAR STREET, EVERETT, WA 98201 <br /> I 425-257-861 D - FAX 425-257-8857—vnvw.everethva.org <br /> I <br /> I � ��� Ur c �/ �L <br /> I PROJECT ADDRESS <br /> I 1 � ,✓� (�,M�7�� 7-C. <br /> i Propehy Owne� M1tail Addruss `��� y�`��ZyU <br /> Ciry State/Zip Phone <br /> i <br /> � Tenanl Name Qf Ihis is for a commercial business) <br /> I <br /> � I� 17�:r1 ��II.�Oh�?iY�S! � 7 S� S y �'r S{-. S1= �'7o�7u.�'CL. �✓� �'/�'Z�7L y,�S 7(.,Li fr 3C�U <br /> i Contractor Mil Adaress Ciry Sta!efLip Phore <br /> � ,,,�G-� P��- Ss, 350 o5 � � 3s <br /> IWA State Contractor License Number(mquired) City of Everetl Business License Number(requirod) <br /> Work to be done: <br /> I ❑ Side Sewer Repair <br /> ❑ Side Sewer Alteration <br /> I <br /> i <br /> � ❑ Side Sewer— New Installation <br /> � <br /> �'Install Backwater Valve (outside lhe building) <br /> � <br /> ❑ Cap off Sewer <br /> ❑ Install Watei Meter <br /> �e �O o'd� <br /> I � <br /> 4� ��_ �- ��—(� • PERMIT# <br /> S�gnaturo �Oale <br /> i � I�D��O�� <br /> fi:1'IS:D it/1�014 <br />