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,��� <br /> � UTILITY PERMIT APNLICATION <br /> CITY OF EVEFcETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98?01 <br /> 425-257-8810 - FAX 425-257-8857 —www.everettwa.org � <br /> jq�6 ��c�c�i���. Av� <br /> �� <br /> PROJECT ADDRESS ��s <br /> V��� V lfJ�� � ��V ����<<a�c� ►��� C`ve��C �� ��d� �V�' � <br /> Fi�U 6 <br /> Property Owner Mad Atldress Ciry Slat iL�p Phone <br /> � <br /> Tenanl N e Qf this is for a comnercial business) ^ / <br /> v��l�- <br /> Ab. �l ��� �� o � L�65-- � <br /> u�� e�R- �--�s �' �� . S,w �i � �g a� � <br /> Contracior Mail Address Gty St e/Zip Phone <br /> Absolss 8�1� � os� �aa _ <br /> WA State CoMractor Li e Number(required) City of Everett Business License Number(required) <br /> Work to be done: I <br /> ❑ Side Sewer Repair I <br /> � Side Sewer Alteration R��u-G(�i�U� <br /> ❑ Side Sewer — New Installation <br /> � Install [3ackwater Valve (outside the building) <br /> ❑ Cap off Sewer , <br /> ❑ Install Water Meter <br /> FEE • <br /> �v O� <br /> �' � � s PERM]TN <br /> � ,�c��� o� � I _ <br /> S�g�aWre . � ( � D�'O , l� <br /> ��r <br /> REv�SED rvi4".O�a <br />