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� UTILITY PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREE�i, EVERETT', WA 98201 <br /> 425-257-6810 - FAX 425-257-8857 —www.everettwa.org <br /> I601 �e�mof�e.J A� <br /> PROJECTADDRESS <br /> I,�; �I►'� �� �L� � <br /> Property Owner Mail Address City Stalel7ip Phonc <br /> Tenanl Name (�f this is for a comme�cial business) <br /> (/��e �WP�S� G'�nS�iU��'o-n �i,�F p0 /�X l�1�7 ( �/'✓�o✓1io-P, (it/1� iP272 <br /> Conirador MailAddress City State2ip Phone <br /> I�FL (�.��cL���f / IN� �__78 <br /> WA State Conlractor License Number(required) City of Everelt Business License Number(required) <br /> Work to be done: <br /> O Side Sewer Repair <br /> ❑ Side Sewer Alteration <br /> ❑ Side Sewer — New Installation <br /> �,�i' Install [3ackwater Valve (outside lhe building) <br /> � <br /> O Cap off Sewer <br /> ❑ Install Water Meter - --- <br /> P[L=� <br /> � �0� <br /> �� / /S =_--__ _ <br /> 7 C� " � � / PERMITi1 <br /> — � - - �T' <br /> �grfature Ualc � I �O� _�� � <br /> P[NsrD nnn^o�a <br />