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UTILITY PERMIT APPLICATION <br /> CITY OF EVERETT �ERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 —www.everettwa.org <br /> �l I t,t k°��°.�tle <br /> PROJECT ADDRESS ��-��/- <br /> T��1 �- n�n,� aia��,�� F�,t�rn� r,c��} axar� l�8 <br /> Property Owner Mail AdAress City StatelZip PRone <br /> l7 <br /> Tenant Name (If Ihis is for a commercial business) <br /> ��cc� �-�l-Sic1e SP,ul�./'� L.LG Cyzs> <br /> ^�� �,�o� I�e.l,�n da �V��� W0. �t�'�iD3 z.y�� �ia59 <br /> COnirador MailAddress City SlatrlLip Phone <br /> �.�Z �� S�� � K � h53 ��l8 <br /> WA Slote Contractor License Num6er(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 /> ❑ Instali Water Meter FEE <br /> 3v G� <br /> PERMITIt <br /> Sig al e Dale � I I � I �� f�( � <br /> `-(' lJ /�_. <br /> RfVISFD H/iW1011 <br />