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UT�LIT`l( PERMIT APPL.ICATION <br />C11'Y OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257=8810 - FAX 425-257-8857 — www.everettwa.org <br />C' �' <br />..��� �,1�.� � <br />PROJECT ADDRESS <br />� �.-�2`�� <br />r <br />�e,��l 3 ��� ee� �i � v �.t ►2�j 2�� Z �ce.� vi.( �,t2 ��%���;�--�� � . �� ` 2� <br />Property Ow%ief Mail Address City State/Zip Phone <br />is�e i.�' if`� � - <br />Tenant Name (if this is for a commercial business) <br />_�{ G '�-^ � ""� ; L s,lr'1 .,,, �+! F'._: �f iG 8�"� "` �r'6 �S.*'�,.. t.'''' �' P �.5 :/"".^.. � � G' ^�.,:`— �' "` � . � � ..� �f <br />-� -� � .�� C:,:.� �-. ! � x� P�� �: � <br />Confractor Maii Address City State/Zip Phone <br />� ���i�- �� i ,��_ 4`��� � 1� 1— <br />WA State Contractor License Number (required) <br />Work to be done: <br />❑ Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer — New Installation <br />f <br />Q�Install Backwater Vaive (outside the building) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />_.� <br />� <br />REVISED 91/19/2014 <br />C-'', � ��1� �s� <br />City of Everett Business License Number (required) <br />� � �� r l ,� <br />.�- <br />FEE <br />�/ <br />�?�n. <br />PERMIT# <br />U I'�o2� i�Z <br />