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I _ _ <br /> UTILITY PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CE=DAR STREET, FVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 -www evere�tv:a org <br /> I <br /> � <br /> I <br /> � <br /> _/„ 93�C���_� _- - - . - <br /> PROJECT ADDRESS <br /> I _��r�.. L; z�t._ I� I��octi -- -C�9 3U C'���o�� �cO �vPifkli_CtJ/4 �/z5-�UZ 3Sz3 <br /> PioperiyOwnCr lda�I�OCress C�ly Sta1c�Z�p Phr.ne <br /> � Tenant Name(II this is for a commerc�ai business) � <br /> � P.v��� F-r� F 1'1 L��1' C.�C— — �� I,��?���� � � L��i I� IVi�D�i�, (J.J��� �)C) c�(_�I <br /> ;� _------ - ] -- --�— <br /> I Contrac�or L�a�i�ddrlr.s Cd� Stale2�p Phone <br /> 7C� lp - F`jU -7 �� fz ; <br /> � �t'�vPr_FL � � U� ��`� —��+�-7c1� I <br /> I ::':� J!ale Cor-Irac,cr I �:er;e PJumber;reoiar���w �:.�y ol Cverett (�:s�ness I.�crnse Number�reqwred) � <br /> jWork to be done: I <br /> i �Side Sewer Repair <br /> I <br /> I ❑ Side Sewer Alteratic n <br /> I ❑ Side Se�ver - New Installat�on I <br /> � <br /> ❑ Install Backwater Valve (outsicie lhe huilding) <br /> � <br /> ❑ Cap off Sewer <br /> iO Install Water Meter FEE <br /> I �� � <br /> ----- -- --- <br /> ./l � --__------/ '2��� -�`�----- NeRr�na <br /> Signalure Ddle I I I 1 I I � Q�I <br /> �� ,� <br /> ir��:��t.�ir,•a�iii <br />