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' - - -- --- - - --- - -- - - --- -- ---- - <br /> -- —--- <br /> , � - UTILITY PERIVIIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> � 3200 CEDAR STREET, EVERETl-, WA 98201 <br /> 425-257-8810 - FAX 425-257-6857 —www.evereihva org <br /> � <br /> � , / / <br /> i7aS }}OV�" �✓e <br /> _ � <br /> PROJECT ADDRESS <br /> il �o%•.,�! Bel.�e ���s �//o�,� A�e �vece � qF� J <br /> I Property Owner 1.7aii Adtlress � C�ty State/Zip P�one <br /> �I <br /> Tenant Name Qf ihis is(or a commercial business) <br /> SH�? 7i =' !?�c /V_F �r v�`1�� 9Fi.z7D <br /> 6� ol/a E/�.�,�; <br /> IContraclor Ma�lAddress Ciry SlalelLp Phone � <br /> ' C� 53�55 <br /> � �o��Pi � D3i.r <br /> WA State Contractor License Number(required) Gty of Everett Business Licanse Number(required) <br /> Work to be done: <br /> �ide Sewer Repair <br /> ❑ Side Sewer Alteration <br /> I <br /> ❑ Side Sewer — New Instaliation <br /> I <br /> ❑ Install Eiackwater Valve (outside the building) <br /> � <br /> ❑ Cap off Sewer <br /> �I <br /> ❑ Install Water Meter FEE <br /> � �3D "- <br /> i <br /> � �-� - /S PE�MCT� <br /> Inal e Date � I�/,� I II�1 <br /> �> > 1 - - 1 <br /> , , . - „ <br />