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� . <br /> � UTILITY PERMIY 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 ��Ef' C.O In�.l�tr��- <br /> PROJECT AODRESS <br /> YV1 r,tr�mal�P W ` � ��( ��Q�c.c� GInJ� ��Nn�ir�[�h��-� ���� �-�g� <br /> Property Ov✓ner Mail Atltlress City State/Zip y Phone <br /> Tenant Name(If this is(or a commercial business) <br /> �-� ;�� wl..S��. p��O� ��� � �J C��3`� � YR1, I�.�(SL, Q$`�D� ��'?�131 <br /> Contracto— r�i MaitAddress City State/Zip Phone <br /> �{�� l�S�l c�c�5 V1ti q _ ��') � a2��-( �1.3 <br /> WA State Contractor License Number(required) City of Everefl Business License Number(required) <br /> I <br /> Work to be done: <br /> ' �d" Side Sewer f�epair <br /> .- <br /> ; ❑ Side Sewer Alterat�on I <br /> ❑ Side Sewer— New Installaiion <br /> ❑ Instail Backwater Valve (outside the building) <br /> ❑ Cap off Sewer <br /> ❑ Install Water Meter <br /> FEE <br /> � �jD.�� <br /> O�� PERMITIt <br /> Slgnature �Ua e ' 1 ���� O� � <br /> U � <br /> RFV�ScD i vr o,yta <br /> "_ '_ _'__ __J <br />