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. UTILITY PERMIT APPLICATION . <br /> CITY QF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257=8810 - FAX425-257-8857—www.everettwa.org <br /> ���, vV Py�hn�tP.o /' <br /> PROJECT AODRESS `�Z'�� <br /> �d S�` �'-�e„� 1�301 c,t�e���noRP EJ�i2�L� C(J� � 35Q—��'C ! <br /> Property Owner Mail Address � Ciry 5Wte2p Phone <br /> i v <br /> Tenant Name(If this is for a wmmercial business) <br /> (�i25) � <br /> � S5 �,�u� l���l��� da CV��ii wa �t�3�o3 ,���ti.���;� G <br /> CoNradof MailAddress City SlatefZ�p Phone <br /> /� Mw�iS� �� � K � ��� °��lP> <br /> WA Stete Contractor License Number(required) 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 /> 0" Install Backwater Valve outside the building) <br /> 0 Cap off Sewer <br /> ❑ Install Water Meter �E <br /> ..�0`'� <br /> ---_ �� '7 'J " I S PERMIf# <br /> Si9 at ` , � Oate u f 5 O � � O�I <br /> REVISED IId8R010 - <br />