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UTILITY P�RMIT APPLICaTION <br />CiTY OF EVERETT PERMIT SERVICES <br />3200 CFDAR STREET, EVER[TT, WA 987_01 <br />425-257-8810 - �AX 425-257-8857 —www.everelhva.org <br />.383o WETMo2�- E✓�2�7T, cr�,� �'i�ZDI <br />PROJECT ADDRESS <br />SaM� <br />Propeity Owner <br />p�NNls <br />t,7ail Adtl�ess <br />D�viS <br />Gly <br />SIaIe/Zip <br />Pnone <br />Tenanl Name Q( Ihis is for a commercial business) <br />syo 7 7/ sr Q-✓�- ��/zs� <br />�4PoL�c: Pc.c/M3�n�� M,4-RYS✓1(,LE C<JA �lg270 387-�5 % <br />ConttaC�or Mail Address Cily State/Zip Phone <br />A-PULLPC-io3L� <br />WA Stale CoNractor License Number (required) <br />Work to be done: <br />❑ Side Sewer Repair <br />O Side Sewer Alteration <br />❑ Side Sewer — New Instaliation <br />�Install Dackwater Valve (outside the building) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />Fev�sEo ivis2cie <br />d s .3 yss- <br />Cily ot Everelt Business License Num6er (iequimd) <br />I- �s -is <br />FEE <br />30°0 <br />PERMIT�i <br />U � � �� - ��0 <br />