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. <br />UTILITY PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />320� CEDAR STREET, EVERETT, V�lA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />L� f I oj + 1+ � j' £V'��....u-rr �. 9G�zo l <br />PROJECT ADDRESS <br />���Lw� ��ol �9+'� S7' C✓cx�c'r1- tn/�i . 5'8'u'� `�tt- 3��- 3r2 <br />Properly Owner P1a�l Atldress Gty StateiLp Phone <br />Tenant Name Qf Ihis is for a commerual buvness) <br />�,26 ii <br />,���-2n ��-L/!MS/N(-f Q�,�OX��i�1 .�Nt7(�-�7N�-t�N wr±. I�Q-�� ICiP D`�7'Z�j <br />CoNractcr htail Atldress Cuy State�Z�p Phone <br />Es^G�'—,=„°':_: �wt.vQPLQ���1 <br />:^.'A State Contractar License �umher (required) <br />Work to be done: <br />❑ Side Sewer Repair <br />❑ Side Sewer Alteralion <br />❑ Side Sewer - New Installalion <br />� Install Backwater Valve (outside the building) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />GEV�SED i In1^O1: <br />os33 Ss- <br />City o( Everett Business License Number (required) <br />FEE <br />_3D p � <br />PERMIT� <br />� 150�-05�1 <br />