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UT�LiTY 6'ERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVECES <br /> 3200 CEDAR STREET, EVERE7T, WA 98?_01 <br /> 425-257-88�0 - FAX425-257-8857—wmv.everettr.�a.org <br /> l�l � � 1��� A� � <br /> PROJECT ADDRESS <br /> �o..c,ti e l Mo.rk; .-� 1 �1� l �E o Yi- f�v� �, ��r� �w Pr' <br /> ProperlyOwner tdailAddre:s Clry Statdzip Phone <br /> Tenant N��s for a commercial business) ����b— <br /> �,,,,,�„� � �j �,� 3 �F1 S" � ��b�La 7�7� <br /> Contractor ldeil Addmss� City p Phone <br /> Se W�-�L�►�� r-�s p t-I � 7�i � <br /> :"JA Sl2te Conlradar License NumDer(tequlte� City qf Everett Busincss Liccnsc Number(required) <br /> Work to be done: <br /> � Side Sewer Repair <br /> ❑ Side Sewer Alteration <br /> ❑ Side Sewer— New Installalion <br /> � Install Backwatcr Valve oulside thc huilding) <br /> ❑ Cap off Sewer <br /> ❑ Instali Water Meter FE� ---- <br /> �O� <br /> I <br /> I ��r�� � yr�_�� _ _ PERMIT# <br /> S�nna�ure Dato � I�` � _ 0/� i <br /> �� <br /> RE�75s��rnw7Jf� _ _ I <br />