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r <br />UiILIiY PERIlIitT i4PPLIC�1'iOtV <br />�ITI� OF EVERETT PERMIT SERVICES ' <br />� 3200 CEDAR STREET, EVERETT, WA 98201 : <br />425-257=8810 - FAX 425-257-8857 — www:everettwa.org <br />% ��� � r ; <br />f�r v.,i�. <br />PROJECT ADDRESS <br />1 _ o . ,�, r �� <br />Property Owner <br />Mail Address <br />Tenant Name (If this is for a commercial business) <br />City <br />C ��� <br />�' ,,,- <br />,C •- � l `� _. <br />State/Zip <br />�� <br />Phone <br />` ^� .�n � '.` �t� v � _.. a=., r ��'1�.�,� . ... �-�r <br />%1��,'.� � � . ��:. `�..��' �-�i �'..L G'l r,i �, �� i,t� '� k:.:,� �� �S°�' � 'i �`� ��"7�-j � „�..'-t �-L•'-' � 4t � 1 <br />Contractor Mail Address City StatelZip Phone <br />' J �/ t,, <br />'� ��,�' i'"1, � ��� ��> � 4 1 � . . �p � � y(� � " ��: <br />WA State Contractor License Number (required) City of Everett Business License Number (required) <br />Work to be done: <br />❑ Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer — New Installation <br />� <br />E�Install Backwater Valve (outside the building) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />7 _ ` <br />G <br />Date <br />REVISED 11/18/20i4 <br />'_ `� <br />FEE <br />��O �% <br />PERMIT# <br />U 11�D2� � <br />