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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 /> ��� 9 �.���f- � �,e, ����1 <br /> PROJECT ADDRESS <br /> �,M S k �'�r 5�� ��7c� <br /> Property Owner Mail Address City StalelZip Phone <br /> i <br /> � � �- S � �e�,��. <br /> Tenant Name (If this is for a commerc�ai business) <br /> �(w���� ?J .��,���w� i���"�z�� �SY �'/3/ <br /> CoNraCtor tda�l Address City State/Zip Phone <br /> f-f0 L� YVl s �� /�9C�_�_� � i� a (�`� � � <br /> WA S ate Contraclor License Number(required) Ciry of Everett Business License Number (required) <br /> Work to be done: <br /> �de Sewer Repair <br /> I <br /> ❑ Side Sewer Alteration i <br /> ❑ Side Sewer — New Installation <br /> ❑ Install Backwater Valve (outside the building) <br /> ❑ Cap off Sewer <br /> ❑ Instali Water Meter <br /> FEE j <br /> � �- � <br /> � 3�,0°- <br /> G' �— � PERMITn <br /> ignaWre Dale� �O� � O�l 71 <br /> U �, �aV <br /> FEVISEO I I/19Q01J <br />