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UTILITY PEaiVIIT APPLICATlOf� <br />CITi Y OF EVERETT PERMlT SERVICw.� <br />3200 CEDAR STRFET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwaorg <br />3 � l � ��� �- E,�,�.�-+ <br />PROJECT ADDRESS <br />� � w, �e..��.�e � � � 3 �'� S� ���( �-✓%- 360 �?�t �� <br />PfOperiy Owner Mail Address Ciry Slate2ip Phone <br />Tenanl Name (I( this is for a commercial business) <br />Contraclor <br />PIU✓hhiny/ (751 S �l ��-r S/-. S� �o�or-.i�S� �"�� r'/� <br />Address <br />m oe� P(�� � � 3 5 v <br />WA Sfale Contractor License Number (required) <br />Work. to he done: <br />❑ Side Sewer Repair <br />❑ Side Sewer Aiteration <br />❑ Side Sewer — New Installation <br />City <br />�Install Backwater Valve outside the building) <br />❑ Cap off Sewer <br />❑ Instali Water Meter <br />' ��/ <br />REVISED f 1/19ROfd <br />� -�-2- (S <br />Date <br />Stale/Zip <br />as���3�0 <br />Phone <br />osz�,635 <br />City of Everetl Business License Numher (required) <br />FEE <br />�O'� <br />PERMIT# <br />U L�O L - ( ( `� <br />