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, <br /> UTILITY PERMIT APPLICA.TION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257=8810 - FAX 425-257-8857—www.evereriwa.org <br /> �� IrJ W�+wwRe h'J'� _ <br /> PROJECT ADDRESS <br /> � CKZS� <br /> a,Frl�.�ie ����4,� !'tl5 wv4-,r+ea�- �4ur� f�1�12J6T� GcJ�._ QB�o� �37—o6z? <br /> Property Owner Mail Address Cily State2ip Phone <br /> ��J��. <br /> Tenent Name pf this is for�.commercyl��ing�)�w� <br /> ��jCa..�l. rvc�}�c w�,e� d <br /> (425) <br /> � S� ��o� La�.l�h da r�v��"A- wa q8a.o3 zv�t--�as9 <br /> Contractor Mail Address City State2ip P�one <br /> � M'k,FZZ �,� S�6 � K t— c553 5�lP <br /> WA State Contractor License Number(reqwred) 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 /> � Install Backwater Valve outside the building) <br /> ❑ Cap off Sewer <br /> ❑ Insta� Vfdter Meter FEE <br /> 3ooO <br /> ��' PERMIT� <br /> Sig at Dete �I/]„I '") _ ! O� <br /> � G �� <br /> REYISED if/1340f1 <br />