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� UTILITY PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 —www.everettwa.org <br /> i� � ��� <br /> PROJECT ADDRESS <br /> EU2A-g�t-L-I- t.vCT-�K� 1'ZrLI C�t.� E�t�2� v�' S'SZo ( 4 �ti��34 <br /> PropeAyOwner MaiiAddress Cny ` Sta�e�2�p �� '�hone <br /> Tenant Name Qf this is for a commercial busness) <br /> -�D P(.�r.3i N�- Po �o,� �87 .S� � �� . Sv°2 9 / 20� �ocn �9 2q <br /> Confraeto: �dail Address City State/Z�p Phone <br /> �-It�Pf'LQ(o3� 9- oS333� <br /> WA Stale Contraclor License Number(required) Cily of Everelt Busmess License Number(requued) <br /> Work to be done: <br /> ❑ Side Sewer Repair <br /> ❑ Side Sewer Alteration <br /> ❑ Side Sewer - New Installalion <br /> !�install E3ackwater Valve (outside the building) <br /> � <br /> ❑ Cap of( Sewer <br /> ❑ Install Water Meter <br /> FEE <br /> ��oOc� <br /> g� �� � � �_ PERMTT# � <br /> � a SignaWre Dale � I <br /> U I 50 �}-I �- � <br /> r.EvrsEO nn9no�a _� � <br />