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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 /> 3� � ���cS.� H�� � <br /> PROJECT ADDRESS 2��.- L((p'3 S <br /> �J2 P9-� l� _ 3�24� -�r��c.� ' ue-r�T'v�4 <br /> Property Owner A�1ail Adtlress Clty State2ip Phonc <br /> Tenan� Name (If Ihis is for a commercial business) <br /> �� f� (fx�-e I�r -r�v-�-u�- G�� ��-�11� � -o �2 3 <br /> Conlracbr �Pdail P dress City State/Zip Phone <br /> �4-F'�v��d/ /�°� D�S`�S�SZr� <br /> A tale Conirector License vumber(required) City o(Everetl Business License Number(required) <br /> I <br /> Work to be done: <br /> �' Side Sewer Repair <br /> ❑ Side Sewer Alteration <br /> ❑ Side Sewer— New Installation <br /> ❑ Install Backwater Valve (outside the building) <br /> ❑ Cap off Sewer <br /> ❑ Instali Water Meter <br /> FEE <br /> �30,°�— <br /> � '��G� _ J I` Z � � S PERMIT# <br /> Signalure Date ' I IrOj_' D(�� <br /> lJ "�l :/ �) <br /> FEYiSE011ns?Ora <br />