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� ' • <br /> UTILITY PERMIT APPLICATIQN � <br /> CITY OF EVERETT PERMIT SER;lICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425•257-8857—www.everettwa.org <br /> / 70�- C��Qr s�' u��- �4 <br /> PROJECT ADDRESS ? <br /> �'/ -�eff w�Y Nt5 - ZG 3 -3000, <br /> Propehy Owner Mail Address Cily Iale/Zip P�cre I <br /> . �. . . . <br /> Tenant Name(II th�s is for a commerciai business) ' ' ' <br /> � �� � s ���►�,� �o ��s3-yi �-��,y�v �'��9P.�o� <br /> � Contr�cto� MaA Addrose � City Stale/Z�D P�one <br /> � • <br /> �l��f�[aI n� �11'I.S �1��/7X�-3 <br /> WA Stale Conlraclor I.icense Number(requiretl) . City.ot Everett Business Llcense Number(requhed) <br /> r • • � <br /> � , � <br /> Work to be done: • � � <br /> ❑ Side Sewer Repair . <br /> ❑ Side Se��ver Alteration • • '� • <br /> ❑ Side Sewer — New Installation <br /> �Install Backwater Valve (outside ths building) <br /> ❑ Cap off Sewer ' <br /> ❑ Install Water Meter <br /> FEE <br /> � ���a <br /> _�G�-C/�Rsl� �/�eJhA..�a�s-. /Ti�Z� PERMITN -- <br /> I Signeture � , . � Dete <br /> u , �-� a - oo3 <br />