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I ' UTILITY PERMIT APPLICATION <br /> I CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, [VERETT WA 98201 <br /> 425-257-86I0 - FAX 425-257-8857 - www everettv�a org <br /> 1301 � <_asrno ------- � <br /> , PROJECT ADDRESS <br /> -�",, I <br /> �e, I�t I ►vIG{ y� �j - --- <br /> � ProPertyOvrncr-- � �--f.ta�iAcn�ess�----._ _ — �--- CrY------ 9a!eZ�p Phone <br /> i <br /> ----__---------...-- -___ ._ _.. -----� �--- <br /> (enanl Natm fll lh�s is lo� u co�nrnerr.ial busmess) <br /> Si�e-- j� l.l��ir <br /> i "T .`._' , C- �� �.epr%�t�-ffi-t� _ — ' _ _ ._ <br /> Coriractor 1.11'A]C�n55 Gty 5!a'e'Lc Phone <br /> s ides�� �3K � °`h8a8- ---- <br /> l4'A Stale CoNraclor I.�censo Nurnber �requ^edl G�y cl Everetl Eusiness L�cense N�mbe� (reqwred) I <br /> I <br /> � Work to be donc: <br /> ❑ Side Sewer Repair <br /> I �� Side Sewer ,�Iteration <br /> � ❑ Side Sewer - New Installation <br /> ❑ Install Eiackwater Valve (outside ihe b�dding) <br /> ❑ Cap oH Sewer <br /> ❑ Install Water Meter - — - - <br /> FFF � <br /> i __ �OJ I <br /> �S� PFRMITN � <br /> ��C� � 3� _ _ <br /> ---- _ - - --._. - <br /> -- - : ,;�� « � ��,�� � 15 0 7- D �s_ <br /> ; _ <br /> i _� . �' �.n�a _ . . .. <br />