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UTiLITY PERMIT APPLICATION . <br /> CITY OF EVERETT PERMIT SERVICES .: <br /> 3200 CEDf,R STREET, EVERETT, WA 98201 . <br /> • 425-257-8810 - FAX 425-257-8857 —www.everettwa.org <br /> a�''���{� J <br /> a�3/ V`� � <br /> PROJECT ADDRESS <br /> LezT`H ? ' <br /> Property Ownet Mail Address City SlatelZip � � . � Phone <br /> Tenant Name(If ihis is�for a commcrcial business) � - <br /> �'aw��b�lls � � ur,��na '�0 554� Ev�r�}) l.�q `�87�'0 <br /> Conlf�` Mail Address Gty � Slale2ip - Phone <br /> C�tNt�6� 1� i� Ms � oti � � o � � <br /> WA State Conlractor License Number(reqwred) City ol Everelt Business License Number(required) <br /> Work to be done: I <br /> ❑ Side Sewer Repair I <br /> ❑ Side.Sewer Alteration <br /> ❑ Side Sewer — New Installation <br /> Q' Install Backwater Valve (outside the building) <br /> O Cap off Sewer <br /> O Install Water Meter <br /> FEE <br /> � 3p,°°� . <br /> (�� S PERMIT# 1 <br /> Signaturc Uatc ' I ���� Of Q <br /> 11 �' � <br /> ✓ <br /> �,�,,,�,,,..,,o���. <br />