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I�TILITY PERMIT APPLICATiON . <br /> � <br /> CITIf OF EVERETT PERMIT SERVICES <br /> �200 CEDAR STREET, EVERETT', WA 96201 <br /> 425-257=8"010 - FAX 425-257-8857—www.everetlwa.org <br /> l�ll j �Z� �, <br /> ,PROJECT ADDRESS r��;j� <br /> � G!�-O,nnule�l-�. 1� �l IZ`�5�. ���-�L( Wl.�, � 7�18- 5z 8y <br /> PfopeRy Owner Mail Address City StatefLP Phone <br /> i (� <br /> Tenant Neme(If this is for a commercial business) <br /> (425) <br /> � �� ���� i�,�1�L� da ����i� �� a �t��o3 z.��.���tsa <br /> Coniractor MeilAdd�ass City StstelZ�p Phone <br /> (� M���. 55 �6 � K � n�3 °��f8 <br /> WA State Convactor License Number(required) City of Everetl Business License Number(�equire� <br /> Work to be done: <br /> ❑ Side Sewer Repair <br /> � Side Sewer Aiteration <br /> ❑ Side Sewer— tJew Installation <br /> H" Instail Backwater Valve outside the building) <br /> ❑ Cap off Sewer <br /> ❑ Instail Water Meter � <br /> ----_ �_ �� Z� � �-O I S PERMIT# <br /> Sig et Date ( 1 <br /> tJ <br /> pEYISFD f I/19RDI0 _. <br />