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UTIL.ITY 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 />T��..�:,�—���� �: — �qZ� F�le�;�,5 s� <br />PROJECT ADDRESS <br />Property <br />-s F� �°I Z.� Fj<<,..� ��5+ �JCr�-�- . GJ � 9�-Ul 4zS - 3�t7 -a� l� <br />�dad Adaiess <br />Tenant Name Qf tnis is for a commercial busmess) <br />�o �o <br />Cof1�f2ClOf <br />C�ty <br />r�0555 lokH4, i�k,«:h,..� �,��.,1 Tar.� l� ✓ <br />Ma�l Address City <br />�-Iz�G��� <br />N!A State Contractor License Number (required) <br />Work to be done: <br />� Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer — New Installation <br />❑ Install 6ackwater Valve (outside the building) <br />O Cap off Sewer <br />❑ Install Water Meter <br />� r� <br />Signat <br />FEVISEO i In 9R01 � <br />� zy-�� <br />Stale/Lp <br />Stale2ip <br />Phone <br />� ZI£f-`�1Z� <br />Pho�� <br />0 3 �� z`-1 <br />Ci�y of Everett Business License Yumber (required) <br />FEE <br />�O°� <br />PERMIT� <br />UIS02-l� <br />