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� <br /> U <br /> TILITY PERMIT APPL�CATION <br /> CITY OF EVERETT PERMIT SERV�ICES <br /> 3200 CEDAR STREET, EVERE , <br /> 425-257=8810 - FAX 425-257-8857 —www.everettwa.org <br /> � � ����� <br /> PROJECT ADDRESS <br /> ,� �.���-� t�,�� � �,.- �� �i�, <br /> '-' ��'�''���� ��� City State/Zip <br /> Phone <br /> �o ��� n Mail Address r <br /> P perty Owner <br /> � . ^ <br /> ;� �, r <br /> Tenant Name (If this is for a commercial business) <br /> .� �,,:�,- , c-, `i�: � --> C`�z� ` `� ' `t <br /> .`�c'� '�' � ,;,�l f c� �d�, L�U�_�--��l` 1,.., : : " _ <br /> ��::��= StatelZip J Phone <br /> � City <br /> Contractor Mail Address <br /> I F" h'� •� 4`^) �f�/ - <br /> !� ''�'�'`r- �i�;'� � ` �- � � ,"` City of Everett Business License Number(required) <br /> ; -ti l_ � �? �''—�.'---- <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 /> ,� <br /> �Install Backwater Valve (outside the building <br /> ❑ Cap off Sewer <br /> ❑ Install Water Meter FEE <br /> �� � <br /> � ,�� <br /> T w PERMIT# <br /> ` ' ��� <br /> � � U � �J��'� <br /> �'—' , ` - Date <br /> , <br /> ' Sig at e�, <br /> REVISED 11/19/20f4 <br />