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UTILITY PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STR[ET, EVERETT, WA 98201 <br /> 425-257-8810 - �AX 425-257-8857 —www.everetiwa.org <br /> 1732 �./e�norG <br /> PROJECT ADDRESS <br /> ��y�c N�Wa�n <br /> Property Owner A1ail Address City StatelZip Phone <br /> 7'enant Name(I(Ihis is for a commercial 6usiness) <br /> /117�//a n/Cc/� Diny S�/a7 7/f� /�✓G ^/` ,✓�u�ySd.r�t �� .3�'7 �/So7 <br /> ConiratlOr A7adAddress City State/Zip Phone <br /> ��LL/�G ��i3G % �s3�/SS <br /> WA State CoNraclor License Number(required) Ciry o(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 /> � Install Water Meter <br /> r•ee <br /> 30 c J <br /> — �/ZG� /� PERMIT� <br /> Signature Daie � I � O I I �� <br /> REVlSED 11/1940N � <br />