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- - - — - -- - — -- - -- -- , <br /> i <br /> . UTILITY PERMIT APPLICATION � <br /> CITY OF EVERETT PERMIT SERVICES � <br /> 3200CEDAH SIRFFT, EVERETT VJA9B2C1 V �� I Z- -O(5 i <br /> 425-257-8810 F-AX 475-257-8857 - vlww everettwa org <br /> ( 7 /0-� S � <br /> I <br /> i <br /> LZ � z C�S���f Sf" � <br /> I PROJECT ADDRESS i <br /> 1,��1L�� C1����5�-� __ __ _ - - - -- � <br /> . �__ SIa!e:�,r Vn_ne �' <br /> ��fOD2/1y OYInOf L".a' Addirv, f,iiy . <br /> I <br /> ��, Te�anl Name Q(Ihis �s 1cr a [ornmerc�a� b�5�nr;si � �_�-- -- -- � � _— <br /> I 2.�� . <br /> � ��--�—� --��------�O�,SS TvcF.JYkb�✓s�— r��.r,1�0.--� - — � .cvll— �8/(0�_--- y�-�2'�?ZS <br /> I Contractor 1.•a��Adaress Gly S!alc'7❑ Phc�c , <br /> i � <br /> I a37�Z � � <br /> �_+4��_i_zz� -- <br /> 1VA Siale Conlratlor�, �cense Numher (requrtetll Cdy o1 Fvere't Nus�ness ; i�erce Number(reqwred) �. <br /> I <br /> i <br /> ' Work to be done: <br /> I <br /> Side Sewer Repair , . <br /> . <br /> � _ i <br /> ❑ Side Sewer Alteration <br /> � <br /> i <br /> ❑ Side Sewer - New Instaliahon � <br /> � <br /> ❑ Install E3ackwater Valve (oulside ihe building) ��j • I <br /> � i <br /> ❑ Cap off Sewer � � <br /> ❑ Install Water Meter - - -- --- -- — � <br /> FEE <br /> ���� i <br /> --- - - -- -J <br /> - — --- - � <br /> PERMIT# <br /> ------S�qnature ---'------ -� —�-- � Dale r VI� I L� �I� <br /> liPl'SY::.�"�G:��I <br />