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�-=---- -� <br /> UTILITY PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8610 - FAX 425-257-8857 -www.everettwa.org <br /> f7 �� � �ah S% <br /> PROJECT ADDRESS <br /> Cc�IV%n +�✓,'i1GiD l� �S� 67 <br /> Property Owner Mail Address City SlatelZip Phone <br /> Tenant Name (If Ihis is for a commercial business) <br /> /4'�a//U �/un�,� 9 S�/G7 7/ �.4vG.�r MU✓YS✓l/�G t�f�-�qR27� '3�fJ- / o� <br /> CoNfaCtor Mai A� City StalelZip Phone <br /> f1 PaG I I�L f1o3L T G-S3�/S-�" <br /> WA State Conlractor License Number(required) Cily of Everetl Business License Num6er(required) <br /> Work to be done: <br /> ❑ Side Sewer Repair <br /> ❑ Side Sewer Alteraiion <br /> ❑ Side Sewer - New Installation <br /> �Install Backwater Valve (outside the builciing) <br /> ❑ Cap off Sewer <br /> ❑ Install Water Meter — <br /> FEE <br /> � D�CU <br /> - f/Z Z/�� PERMITN <br /> Signalure Da�e f ' I � O I � I � � <br /> U � <br /> RlVISfD 11/I9n,OfJ <br />