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� - - <br /> ---- - - - _-- -- <br /> -- -- --_. _ <br /> _ - <br /> ' UTILITY PERMIT APPLlCATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> � 3200 CEDAR STREET, EVERETT, WA 98201 <br /> I 425-257-881�i - FAX 425-257-8857 -www everettwa org <br /> � <br /> G�/0 C�/� � �'D <br /> PROJECT ADDRESS <br /> � �[ �i � <br /> ���. �/� Q��� <br /> J� -- -- — Sta1cIZ� Pnone <br /> Pioperty Owner Ma�l Address C�ty P <br /> -- �-- --- . __----�----..— <br /> Tenant Name (If Ih�s �s for a commerclal bus�nr.ss) <br /> �2�. N-�— i�"� ����~-____��//� 9d°y� �s_��zz, � <br /> ConlraCtor Ma�l AdOress � C�ty StaleiZ�p Phone yY <br /> / <br /> /2eSu� � 0 � 7Q-7 _ p� z � �3Sl <br /> W� Siate CoNractar License Number(requueA) Cdy ol[vr,relt�usiness License Number(requtred) <br /> I Work to be done: <br /> � � Side Sewer Repair <br /> ❑ Side Sewer Alteration <br /> I <br /> ❑ Side Sewer - New Installation <br /> ❑ Install Backwater Valve (oulside the bwlding) <br /> ❑ Cap oft Sewer <br /> ❑ Install Water Meter FEE � <br /> 3��0 <br /> i / � � �S' /� PFRMIT� <br /> ignature <br /> --- Date —f u I '� I I - �5g <br /> REVIShU 1✓19:Ou . . <br />