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UTILITY PERMIT I <br /> APPLICATION � <br /> CITY OF EVERETT PERMIT SERVICES . � <br /> i <br /> 32C0 CFCPR STREET, EVERETT. WA 98201 <br /> 425-257-88 i0 - rAX 425-257-8857 -wvr�v everettwa org ( <br /> � � v <br /> � PROJECT ADDRESS � <br /> � 'Ca.v _�L.e <br /> � F�roper,yCwner MauA��ress CAy Sta�e2w anor,e <br /> i I <br /> � �cnant Name QI Ihis�s 1or a commercial buslness) '� <br /> l�tr3- P 1�� �� vt�, LL� �'� �I U t S fi�z rawz-`� GI-z 1`-Ll 8 S-t�i � ; , <br /> � ..��dractcr 1dadAdOress Cdy State/Lp Phone ,� <br /> � �fJ 1 �,�-t �� vt� 1 y�Q_j�L Pl�l�0//J°� -(Z�� 5 S'� , <br /> ':l%� SL3'e Ccnl�ar,lor I_icr.nse 'Jumb eqwretl� Qty ot Evereft Husmess License N��mber(repuire0j � <br /> I <br /> I <br /> Work to be done: <br /> I � <br /> � [�Side Sewer Repair ' <br /> ❑ Side Sewer Alteration <br /> I <br /> ❑ Side Sc��ver - Nevd Installation <br /> O Install Backwater Valve (outs�dc lhe budding) � <br /> ❑ Cap off Sewer <br /> ❑ Install Water Meter I <br /> FEE UO i <br /> �7 � � � <br /> � <br /> � — _� <br /> 3-v- � sr_ PERM[T.", � I <br /> gnalure Date � I <br /> ��a3- oz�� , <br /> REVr5E0+in9:Gf+ , <br /> — _ — _ . _. ' —.__. --_ _ ___ ._ " 1 ' <br />