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�— -- ------ - <br /> UTILITY PERMIT APPLICATION ; <br /> CITY OF Eb'ERETT PERMIT SERVICES <br /> 3200 CEDAiZ STREET, EVERETT, WA 982U1 <br /> 425-257-8810 - f AX 425�257-8857 —www.everettwa.org <br /> �fX�� �`t��(o�re... A-�� ���` <br /> PROJECT ADDRESS 3�O- <br /> � u� �Q �W I��1 rJ��Y �IJZ V`� ,W� �`�IM.QI V'�� �"o` 1� q�7� <br /> Prop y0wner hlaiiAtldress y Slat IZIp Phone <br /> Tenan Namc Q(Ihis is for a commercial business) ap(�, <br /> A� �le, C���, I l y6s� <br /> e��� wer �a3 a�����s��s . cPyu�4� �� ��� NI�13 <br /> Contraclor Mail Address ily St IelZip Phone <br /> .�g � � 5 c���g2o <br /> WA State CoNraclor L� ise Number(required) City of Everett�usiness 1_icense Num6er(required) <br /> Work to be done: <br /> ❑ Side Sewer Repair <br /> � Side Sewer Alteration <br /> ❑ Side Sewer — New Installation <br /> m Install Backwater Valve (outside ihe building) <br /> ❑ Cap oft Sewer <br /> ❑ Install Waler Meter <br /> FEF <br /> � �� <br /> -�11' � � ✓ � � �"� ! � P[RMfi'Jt -- <br /> \�\�gna�ure Uatc � � Oq _ n-7 <br /> � � I �V I <br /> �eev6en i vionnie <br />