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UTILITY PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 320U CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 —www.everettwa.org <br /> 1 �2D l✓��m � �e, <br /> PROJECT ADDRESS <br /> �A.. C=s�o/�r / �2G �j/.v�,nor--t. ��{r �G �� !-✓� r7�2o3 <br /> Property Owner ldad Address City SlatelZip Phone <br /> Tenant Name (I(ihis is for a commercial business) <br /> � � ��rT oS.,o%s,..S �'/DDy��r�d•.n /✓�.'�1'or+ /;�yt �L��J �/ Sl38Z�.� ��.�6 <br /> Contractor Man Atltlress City StatelZip Phone <br /> s�w�2T� 89� � o,�0 7 Sy <br /> IWA State Contraclor License Number(required) City of Everett Business License Number(required) <br /> i <br /> � <br /> Work to be done: <br /> ❑ Side Sewer Reoair <br /> i <br /> ❑ Side Sewer Alteration <br /> ❑ Side Sewer — New Installation <br /> p Install Dackwater Valve (outside the building) <br /> i ❑ Cap off Sewer <br /> ❑ Install Water Meter FE[ <br /> ��c 6 <br /> /�2/j.j PeRr�rra <br /> Signature � I I / L-, D /� 0 D � <br /> l.l -/ 1 <br /> PCV15:011/19�.J:� ----. " __ __ __ ___ __ <br />