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i _ _ - _ _ <br /> ; <br /> UTILITY PERMIT APPLICATION , <br /> CITY OF EVERET'i PERMIT SERVICES � <br /> 3200 CEDAR STREET, EVFRETT, WA 98201 <br /> 425-257-8810 FA?C 475-257-8857 - www everettv+a org I <br /> I <br /> � <br /> ' Z 2 3 1 Cl,�s�r,� � S� <br /> PROJECT ADDRESS I <br /> / S���� � <br /> +r��+� 'II rlr t 1t� <br /> Proper'yn e7._ ��/�I � I.tai ddrr.ss � —_--� ' GRy -------�- �'� Sta!e/Z�P Phone <br /> � _____ " <br /> __—__. _ _ _ __'_" _—'_' . . .__......_ I <br /> _ _" _' ' ' . ' __. _ _ <br /> Tenar'Name (if th�s •�s 'o� a commerc�al busciessi <br /> I <br /> . 7.,� <br /> C°vJ0 -,�Y»n� /o%SS T..[.E+�tl4W✓_�I- r��'���`-- - �vfi= �8i�f, �/2s .�3�2zs � <br /> CO'I:r3CI0f 1.fad A^tl�eas C�t� Slale�T�c PhC9C .. <br /> 2�No ;�SL�3�z s,e. 0 3 ��z J �__ _ � <br /> 4NA Slale Cont�acror I ir.rrse Numbe�(reqwreA) City r.l fverelt 13�,ismcss I ir.ense Number(requ�rr.d) <br /> i <br /> Work to be done: <br /> Side Sewer Repair I <br /> i � <br /> ❑ Side Sewer Alteration <br /> � <br /> O Side Sewer - New Inslallation , <br /> I <br /> O Install Backwater Valve (outsidc the building) � � <br /> I <br /> O Cap of( Sewer I <br /> I <br /> i <br /> ❑ Install Water Meter - --- - --- <br /> FEE <br /> � � <br /> / / f./���/li.(// � �� PFRh11Tu =_ _ ' <br /> � Sign i� - -V ---- Date - ---- ��- '--- I rD� 1 <br /> U 50"1 <br /> 4rc,Y��n.raPin� <br />