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_ ----- -- � <br /> UTILITY PERMIT APP_I.ICATION ' <br /> CITY OF EVERETT PERMIT SERVICES i <br /> 3200 CEDAR STREET, EVEP,ETT, WA 98201 �I <br /> 425-257-8810 - FAX425-257-8857 -�vww.everettwa.org / `�_ /�� <br /> l� <br /> � i 566 _v3� <br /> � d o Z i2��-f / ,9 I E q� <br /> PROJECT ADDRESS • Z2 O - /�� �7 <br /> I i <br /> "IrY1✓L t�'-I�-s�1 G�� 2�O Z ���_�I/� �Cf2 � <br /> °roperty Owner P.1ail Address U�Y State/Zip Phone <br /> Tenanl Name Qf this is for a commercial busmess) <br /> Ir 1l7`,��Ultil d��✓� �11���r� �lz� —����--��Z 3 <br /> ICOntractor Mail �tl ress Cdy 5[alelLp Phone I <br /> � �� ����� City o(���ense Number(reqwred) �� <br /> VJA S ate Con�ractor icense Number(required) <br /> Work to be done: <br /> ide Sewer Repair <br /> ❑ Side Sewer Alteration <br /> ❑ Side Sewer - New install�tion <br /> ❑ Inslall Backwater Valve (outside the building) <br /> ❑ Cap off Sewer <br /> � <br /> ❑ Install Water Meter F�E <br /> � 3�.°% <br /> �� � � S' PERMITr � <br /> Signalure <br /> Date U I _J V lD� �J� <br /> r,-:,.�rcimo:'oi� —__—_ __' —.._ —__——� <br />