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I. .. ___..__.. <br />� <br />UTILITY F'ERMIT !��'PLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />a2oo c���i; sr��i_er, rvr-Rer�r, wn s�2oi <br />425-257-8810 - I'AX 47_i-257 f3f3,7 -�:✓c�: evri tiva,� ory <br />., �/� Z����� — <br />PROJECT ADDRESS <br />l�l�-l�ld�- �D` Ll1CG� � <br />PropertyOWner t.tadl�Udre,s �J� Slalc2ip -�—�_- Phonc. <br />Tenanl Name Qf Uiis is for a commercial business) <br />r'.1�u��Nt�il�1��C::�%i�'�G'� ��> ��l`L CT C �' <<d✓!IVj v� q C <br />__%tV l�-f �, "�t�/ c G �(` /y � <br />CoNractor �naii Address t:��v siaieiLip nh�n� - � <br />W�>`-i 3'z- %'/U s <br />� �;;��c-5�j�°� ni�.� -- <br />WA Stale Conlractor License Number (reqwred) <br />Work to be done: <br />❑ Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer — New Installation <br />[5 Ins�all Backwater Valve outside (he building) <br />❑ Cap o(( Sewer <br />��5��/� 7 <br />City of Everet� Ciusiness liccnse Number (required) <br />� ❑ Ins�all Wa�er Meter <br />�-��_ __ J - <br />M �0� <br />- �-�.�(�- �� �- z�� 5' ����,� � r-= --- <br />s�;n,��irt� ---- ua�e —._._ � , , l � O /_ QO, / l <br />U U/ �I I <br />,. _ „>,: <br />� - ---- -- — --- - <br />