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UTILITY PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STRL=[T, EVERETT, WA 98�J1 <br />425-257-8810 - FAX 425-257-8857 - www everettwa org <br />LU � � �d ��i� ��1r ' <br />PROJECTADDRESS <br />�J '� �S_2G1�_I,�i(u�i�iA�—�Q�'-e.�����' <br />Piopehy Otivner 1.ta�i AtlAress Gty S:i'e�l�p <br />I <br />. � 1 . _. _ _' ____'__ <br />� 7�' __ — <br />iendni Name ilf Ihis �5'or N Ccrnm.cC�al L�o ��til <br />�, n_� ���13� <br />�i�1(������i�1�1� �l��L'� • ��Z� <br />�s��z-3Y� <br />IConiraciCr—� _ __F1aa:.tlAicss ._ _— C' _. ___— __ S�a���To--' P.hc-e <br />I—({1—.'.�'��--.�.�---.J��- j-� Qeplie� -�rn. ��(o �S <br />':1A Sta�e Cont� r I�nsc N� Reqaredj � Ci�y of Everelt Business License Number (required) <br />Work to be done: <br />❑ Side Sewer Repair <br />❑ Side Sewer Aiteration <br />❑ Side Sewer - Mew Instaliation <br />%� install Eiackwater Valve (outside the building) <br />�. <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />I ' <br />I <br />' -- __�/v_- zol,5- _ <br />I � �gna Date <br />� <br />. �.�r� ��.-tn:or: <br />N <br />� <br />� <br />I <br />I <br />FEE I <br />�/l� � <br />✓ _ I <br />� <br />IPERh11T� � <br />i u15�3 =�50 <br />