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i.-�.- - -- - - -- --- -- --- -- - - - - <br /> UTILITY' PE`�MIT APPLI�GATION <br /> CITY OF EVERETT PERMIT SERViCES <br /> 3200 CEDAR Sl"REET, EVERETT, WA 98201 <br /> 425-257-£3810 - FAX 425-257-8857 –www everettwa org <br /> ,1� 9 �//S` S� <br /> PROJE^T ADDRESS <br /> D�n1�/ lFu�,t —_ _ _ ._—._ __' ___ <br /> P(OpBfty Ot•mP.r � L1d�!dCtlresS C�;y Sldtail�p P�cr� � <br /> Tenanl tJame Qf Ih�s �s`or a c�n��merc�ai bus:ress; I, <br /> /� ' �c/ 1�L�� _�ELZ--7L�_✓,.�_ .•�,•c1L1liv. ws�9fr19�_ 3�� 1��J <br /> CONfdCtOf � d Ad�reis G!y State/Zip Phone I <br /> /3/�cGL ��L �'3L% G�3�/sf i <br /> bV� Slale CoMracter Lcense `lumber(requred) Ciy of ccerett Business L�cense Number(required) � <br /> Work to be done: � <br /> ❑ Side Sewer Repair <br /> ❑ Side Sewer Alteration <br /> ❑ Side Sewer – New Installation I <br /> I i <br /> ,/L>9, Install Backwater Valve (outside the building) <br /> � � I <br /> ❑ Cap off Sewer j <br /> ❑ Install Water Meter — � <br /> F[E I <br /> �0 `� 'I <br /> �, / ���,� PERMIT,'F j <br /> Signature Date � I � 11�,� 0�� I <br /> v , <br /> REVr5E0 f�n.o�01� � <br /> \ O �� <br />