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i <br />UTILITY PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 96201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />23'�0 V/Q�o/A/f�' /}vJ (�rVVitoTT <br />PROJECT ADDRESS <br />K�?µ(.eev oL��r�� 233o v�r��N��r <br />Property Owner rnaii Address � C�Iy <br />Tenant Name (It lhis is (or a commercial business) <br />,,,, a. . l�8zo / <br />Statc2ip Phone <br />�-ic�eD i�C�Mo3�•�t� PO gox °S7 Sn�4�vm�SN w� ,�/�Z9i 20lnQtYa-o5'LS <br />CoNraelor Mail Address City State2�p Phone . i <br />L-Ft�D P�L�3u.2 <br />WA Slale Conlraclor License Number (required) <br />Work to be done: <br />❑ Side Sewer Repair <br />❑ Side Sewer Aiteration <br />❑ Side Se�ver — New Installation <br />� Install Backwater Valve (ou!side the building) <br />❑ Cap off Sewer <br />❑ Install INater Meter <br />FEVISED t 1/191101a <br />OS 33� <br />Ci�y of Everetl Business License Number (required) <br />30"� <br />PERMIT# <br />U I I I � � ;. �"� � <br />