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, <br /> �r� . <br /> j UTILITY FERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX a25-257-8857 —www everettwa.org <br /> ll�G9 Gve-�,�-��� <br /> PROJECT ADDRESS <br /> �e�'� Po�,.���..� <br /> Property Oa+ner �;;ad Aderess C�ry State2p Phone <br /> 1-enant Name(I(Ihis �s for a commercial bus�ness) <br /> 3S 7 <br /> A�2--+'/o /�/ .�r3,�„� S%7 7/y'"q�e .v�, .�.,�rSv,r�e w/�%���• isG7 <br /> ConlraClor I.tai ddress Gty StatelZip Phone <br /> /.��� ///�L �o3GT GS3 �/SS <br /> WA State Contractor L�.cense Number(requiretl) Gty of Everett Business License Number(required) <br /> i <br /> Work to be done: <br /> ❑ Side Sewer Repair <br /> ❑ Side Sewer Alleration <br /> ❑ Side Sewer - New installation <br /> � Install Backwater Valve (outside the building) <br /> ❑ Cap ofi Sewer <br /> ❑ Install Water Meter <br /> FEE <br /> ��Oo <br /> — - �//e�//S aeRr�rru <br /> Signature ���� I I I ��"� ., O�� <br /> V !� <br /> neviseo i vroaoi+ - <br />