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� UTILITY PERMIT APPLI�ATION <br />CITY OF EVERETT PERMIT SERVICES <br />I 3200 CEDAR STREET, [VERETT, WA 9F3201 <br />I 425-257-8810 - FAX 425-257-8857 - v✓ww everethva org <br />2�0(n l�� �n� �ve_ <br />PROJECT ADDRESS <br />�b��- t-10.��c _�.S _a� e - <br />PrOpCrly O�vner �.1.� i:.cdr�ss <br />CAy <br />Tenant N�me pf th�s is for a commeraal busriess) � <br />r <br />��,� I �.��, �' �_-5.�`-11 <br />Con�faCtor .':1adAddress � C.t, <br />Slalc2 p <br />Phor.e <br />�t%2�2 �`,' L%Q � c� 26�j <br />Slate�2�e Pnone <br />�'A►'�I��P��rl7/�'IS ��_70� <br />b'JA State Canlractor L�cense Number (requ�,red) Cdy ot Everett Bus�ness license Number (reqmred) <br />Woi �c to be done: <br />❑ Side Sev��er Repair <br />❑ Side Sewer Alteration <br />i <br />❑ Side Sewer - New Installation <br />nstall f3ack�vater Valve (outside ihc building) <br />O Cap ofi Sewer <br />❑ Install V!ater Meter <br />� , <br />__ �'LI��S- _1�� 3��_b�� <br />5��9nau,re Date <br />�E <br />��� � <br />— --- , <br />� F>Frir,rr.: <br />u ISo3-�7r� <br />