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�------- - <br /> UTILITY PERMIT APPLICATION <br /> CITY OF EVERETT PER <br /> MIT SERVICES <br /> 3200 CEDAR STREEI�, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 -wv,�w everettwa.org <br /> /Z1ZLo coDa�; ��=. <br /> PROJECT ADDRESS <br /> � <br /> `���'eh�-'-`� 1 u2 (-e �nLl��l �� -{�2T c� <br /> Property0wner Ma�tAddress Cdy StateiZ�p Phone <br /> Tenant 4ame(If this is for a commercial busmess) <br /> 4zr <br /> �v�- �(�,-�-� (o��u r!.� (�i-- l�.,�r 5'd'z od' �`�^° �z 3 <br /> Contraclor 1da tlress City StatelZ�p Fnone <br /> r>979 P l��.�o ii�� D�-� ss� <br /> WA Slate Contractor License Nwrber(required) City of Everett Business License Number(reqmred) <br /> Work to bc done: <br /> ide Se�ver Repair <br /> ❑ Side Sewer Alteration <br /> ❑ Side Sewer — New Installation <br /> slall f3ackwater Vaive (outside lhe building) <br /> O Cap off Sewer <br /> ❑ Install Water Meter — <br /> FEE <br /> �30,� <br /> � —a ^� 5 PERhifi'# <br /> S�gnalure Di1e I I I���1 �%_ <br /> lJ lJ�V7 <br /> REVISED 1fnB20id <br />