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� <br />UTILITY PERMIT APPLICATIUN <br />CITY OF EVERETT PERMIT SERVICES <br />3700 CEDAf1 STRGET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 -�w,nv everetteva org <br />�` l0 � l/� ✓4i �✓� c( /✓��vt—�vc%'��w.B 7d'j o/ <br />PROJECTADDRESS <br />_�rpil/�;.� �lall(� �-`�D �l�l�tNi �d� �Urv <br />� Property Ol•�r.er �.1a1 Aamess Gty <br />�/'v <br />Tenant Na �e (If th�s is (er a ccr�meroal basmessi <br />slateiLp <br />I�y�'�r _s���.��/J��.�'y ���oD( Sr% G ��:rcr G vi�' i'�.�o <br />� --�-----� — <br />, CoNraclor td.l!I AOCress C¢y 5!d!rZ�F <br />Cuir,/�bP.= r/T/� S <br />lNA State Contractor L�cense Number (reqwred) <br />Work to be done: <br />❑ Side Sewer Repair <br />❑ Side Sewer Atteration <br />❑ Side Sewer - New Installalion <br />�Install Dackwater Valve (outside the building) <br />❑ Cap ofi Sewer <br />❑ Install Water Meter <br />� <br />�� %� <br />I �,� -' ✓' �� _ <br />II <br />S�gnalure . D.Ic <br />� ___ r ..:-. ._ <br />Pnone <br />Phone <br />�- a yzZ� 3 <br />Cdy of Eve�ett �us�ness License Number (reqwred) <br />F[E <br />� �jQ.00 <br />j PERh11T±! <br />� � i�f��- �' ��7 - <br />tl <br />