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UTILITY PERMIT APPLICs4TIO�V <br />CITY OF EVEI�ETT PERMIT S�R�lICES <br />3200 CEDAR STR�E7, EVERETT, WA 98201 <br />425-257-8�110 - FAX 425-257-8857 — www everettwa.org <br />��Z <br />nn 1 ��, ;/� Si [� U�c�"7T ►.r�/�— <br />PROJECT ADDRESS <br />� � �= er� 30o f t�� � Sr E �� c�-�rt' <br />Property0wner �dailAddress City <br />Tenant Name pf ihis is for a commercial business) <br />, <br />�G6 — <br />wu�, iB�o 1 20� - �148 <br />Siate/Zip Phone <br />k-Ic�o Pc,.�„�„s3�N� Po /�x 8g7 S�l�,��sN �.r�-. 98z9� 2oe 40� b� i <br />Contraclor Mail Address Cily Slale/Lp Phone <br />�-i �u.o P P L$f� 3 n� 1 <br />WA State Coniractor License Number (required) <br />Work to be done: <br />❑ Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer — N �w Installation <br />� Install Backwater Valve (oulside the building) <br />❑ Cap off Sewer <br />� Install Water Meter <br />/ - �s= �s- <br />IiLVISEU l l/N40�� <br />oS335 <br />Ciry of Everett Business License Number (required) <br />FEE <br />3(��� <br />PERMLT� <br />UI56)- �%;���. <br />