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UTILITY PERMIT APPLI�ATION . <br /> CITY OF EVERETT PERMiT SERVICES <br /> 3200 CEDAR STREET, EVERET i, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 —www.everettwa.org <br /> l��� ��1N1.0 d-'-ei <br /> PROJECT ADDRESS C�S� <br /> �; U �o�l�- ,�v� w�. z3z - ��5y <br /> ��z5 w e�ti a�r. <br /> Property Owner Mali Address Ciry State2ip Phone <br /> I � <br /> Tenant Neme(If this is for a commercial business) <br /> (tizs) <br /> � �� ���%C � ��1��� da ����Ti- wa �t��.o3 z4�ti--4�zsG <br /> Contractor <br /> MeilAddress City State2�p Phone <br /> /� ;Jl�l�1 `�?���o � f\ 1- _ (5'�� `� �{8 <br /> WA State Cont2dor License Number(required) City of Everett Business License Number(required) <br /> Work to be done: <br /> ❑ Side Sewer Repair <br /> ❑ Side Sewer Alteration <br /> ❑ Side Sewer— New Installation <br /> C�7 Install Backwater Valve outside the building) <br /> ❑ Cap off Sewer <br /> ❑ Instali Water Meter FEE <br /> 3voo <br /> -- Z - f j _ �b l S pERMiT'# <br /> Sig et o Oata t I (CUZ '� T g <br /> lJ ✓ <br /> nevisen�+nsaoia <br />