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UTIL�Tlf' PERII�IiT AP�LIC�►�'���9 <br /> CITY OF EVERETT PERMIT SERVIGES <br /> 3200 CEDAR STREE:T, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 —www.everettwa.org <br /> � 30fl ��ss uT� A�� <br /> PROJECT ADf)RESS <br /> 'C�1ri S �.�o�hm 130� K�SSvii,— �'vef�_. <br /> ProOertyOvrn�r MailAddress City State2ip Pi�one <br /> Tenant Name (If this is for a commercial business) <br /> 1�rrC�r -�e_�.k �2� S /5`/t"sT Sc fF W A-.�e�1�� Z4n-25&-52 d <br /> Conl�aclof Mail Address � Cily Stale/Zip Phone <br /> ���co-�� S�5k� bs3 2� I <br /> WA State Conlreclor License Number(required) Ciry of Everett Business License Number(required) <br /> Work to be done: <br /> � Side Sewer Repair <br /> ❑ Side Sewer Alteration <br /> ❑ Side Sewer— New Installation <br /> ❑ Instail Backwater Va!�e (outside the building) <br /> ❑ Cap off Sewer <br /> ❑ Instal! Water Meter FEE <br /> �� Qb <br /> ��� I —Z�-- l5 PeRr�rr# <br /> Signature Oate � I (";,,0 r � � �I <br /> l� 1 l <br /> ✓ <br /> REVISED II/f9R01< _ <br />