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� <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 /> l l� � �ra����,y ��'�� <br /> PROJECT ADDRESS <br /> C�p � pG'!��'�Df'�f /Zo�f /4 ��5�" lni1C2�� .�i'7a�iar�2if�i t/!!/d y'�290 <br /> Property Owner � Mail Atldress Cily State/Zip Phone <br /> � 73�5'/2 9� <br /> Tenant Name Qf Ihis is for a commercial business) <br /> �ir�l�v ��lG -lo/v s� ,l��-��� i���ii tti�-a, �����, w�- �8�� <br /> Conifacior Mail Address � City Stale2ip Phone <br /> �Z�,�a9 oyo� <br /> fi/ 2rL/}L9Sl �G Q`��9GS <br /> WA State Contractor License Number(requued) City ot[veretl Business License Number (reqwred) <br /> Work to be done: <br /> ❑ Side Sewer Repair <br /> ❑ Side Sewer Alteration <br /> ❑ Side Sewer - New Installation <br /> ❑ Install Backwater Valve (outside the building) <br /> �ap off Sewer <br /> ❑ Install Water Meter FEE <br /> � IO , �J <br /> /if���/'��� f�/�I /.LJ PERMIT# ///��� <br /> 5 nalure . ' Date � ( �/��J(�(-V1 <br /> I U V.� I <br /> FCVlSEO I I/19Qola <br />