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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 /> N� <br /> l �da, C e�ar Sf �� <br /> PROJECTADDRESS Lulf� �4 ,'� a� <br /> Kq rcn � hAA/� /70�. Ce�ar Sf Ev���/1` l✓A 9 `O�lo � <br /> PropeRy Owncr Mad AdCress Cdy Slate2ip Pnone '�,. <br /> Tenanl Name Qf Ihis Is lor a commercial busmess) <br /> C'4�pbCIISPI4is,dil�y po �JoX .rS�// ���2�! t.iA 9$ 2a � . <br /> C`"'y�_ — <br /> Contiacto� Matl AOdress Ciry Slale2lp P�one . <br /> ��M�r3�.L 9�7�L�s -�oy��� <br /> WA Slate Contractor License Number(required) City of Everett Business License Number(required) <br /> Work to be done: <br /> Q� Side Sewer Repair � <br /> ❑ Side Sewer Alteration <br /> ❑ Side Sewer - New Installation . <br /> ❑ Inslall Backwater Valve (outside the building) <br /> , i <br /> O Cap ofi Sewer <br /> ❑ Instail Water Meter <br /> FEE <br /> �� �d� <br /> -.._�:� �Z _ 3 r_ ��� . <br /> PERMITk <br /> Siynature Date 1 , I � I� _I`'�'� <br /> U � <br />