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UTILITY PERMIT APPLICATION , <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERErf, WA 98201 <br /> 425-257=8810 - FAX 425-257-8857—www.everetlwa.org <br /> �.1,�L�1 W�e:��r�r�P.�. <br /> PROJECT ADDRESS eu�� <br /> �� �,e.ow n 1�1,Z�1 l,J e ° �A�Q�. �J-'�R�Cfi �G J�v—'-�O= <br /> �� ' �w��,� Phona <br /> Property Owner Mail Address <br /> i � <br /> Tenant Name(If this fs far a commercial business) <br /> (tiZ'i� <br /> A- S� �,��•� i �El��� da �V��-f► wa Gs��.o3 z4�L-��t59 <br /> City StataZP Phono <br /> Contrador MeilAddress <br /> �} Mk.�i 55 �� �, K � _ c5�3 ��f 8 <br /> WA Siele Contrador Ucense Number(required) City cf Everefl Business Licensa Number(reqcire� <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 /> ❑ Install Wster Meter FEE <br /> ��o� <br /> _ �-- 2� '- !�/l S PERMITA' <br /> Sig at• Date I I I � O� _ I I <br /> V <br /> RtVIgD iV1440I1 . <br />