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UTILITY PERNLIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-6810 - FAX 425-257-6857 — www.everettwa.org <br />� <br />�� � ) � JZ41 uL 1 Csz — <br />PROJECT ADDRESS <br />.�/� r � c <br />�/l� _�.. _...� �.�nG�MO 2%�iLl ,�1�LI�I.�G. P�1 <br />Owner <br />Mail Address <br />,T/�e'n�a"n�t N,,ame (It this is tor a cummercial business) <br />7Tw�v'J�W� <br />_ . �_ <br />ConiraC�of MailAtldress <br />Ciry <br />A M�.Rz. �,� S�6 � K t- _ <br />WA Stete Contractor License Number (reqmred) <br />Work to be done: <br />❑ Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer — New Installation <br />0" Install Backwater Valve outside the building) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />—� <br />Fleviseo �insaa�� <br />Ciry <br />Czs) <br />i� L 25Z—��; <br />Slalr2ip Phone <br />(y25 <br />Stale/Zip <br />Phone <br />h5� ��8 <br />City of Everelt Business License Number (required) <br />FEE <br />(z — �O —�-� �� PERMTf# <br />Date � I I I 1�� ,� r-� <br />l.J '"j �U <br />