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Aug 06 2015 08:09AM CJ'S PLUMBING & SERVICE 360-691-1301 page 1 <br /> *kW00" <br /> •ik i -(11-. :— 0 <br /> UTILITY PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 --www,everettwa.org <br /> Dsr. ,1 F--,__ __\--,„ <br /> PROJECT ADDRESS <br /> gi 4, 441' 4PAS6 r A \-- ' 41All <br /> AfAii MS k_Li_ <br /> Property rarer Mail Address City State/Zip Phone <br /> Tenant Name(If this is for a commercial business) (YA C-1 S--9 <br /> C ,5 <br /> tk1/4(1'N.V.). f <br /> ieSTOJ[k. c,C;t (W\'k\UI\it;1 - &P\/W64 <br /> Contractor Mail A d ss City State/Zip Phone q tas- <br /> � <br /> L- S PL cgsk 9 1 c P ()Lir) qui <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 /> pi& <br /> O Install Backwater Valve (outside the building) <br /> O Cap off Sewer <br /> El Install Water Meter <br /> FEE <br /> 4 1 0• °C. <br /> Oc..... OP' <br /> PERMIT# <br /> Signature Date U i @* „D I4 <br /> REVISED 11/18/2014 <br />