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. . <br /> IJTILITY PERMIT 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 /> 0�30 �"�td�'��r � ►J � FVCrE +� . <br /> PRi)JECT ADDRESS <br /> � �,��i `lorfl a?3o H��I+r. �d ��r,.rf�' INA�98�3 Nasas7-�o <br /> Prope y0wner MailAddress City Statn!Zip Phone <br /> Tenant Name(If ihis is for a commercial business) <br /> { S s o .7n6�' S . Va I e $ -3y9-�7S7 <br /> CoNractor MailAddress � Cil StatelZip Phone <br /> D537d8 <br /> WA Stale Contrador License Number(required) Ciry of Evereit Business License Number(required) <br /> U.�� (a�3-o0 z � �S(p <br /> Work to be done: <br /> Q�Side Sewer Repair <br /> ❑ Side Sewer Alteration <br /> ❑ Side Sewer— New Installation <br /> C7 Install Backwater Valve (outside the building) <br /> ❑ Cap off Sewer <br /> ❑ Install Water Meter <br /> FEE <br /> �� °� <br /> ���� �(��{� �"o2I-�s PERMIf# <br /> Signature �ate � I�O' ^ � � � <br /> � <br /> REVISED If/I9R0f0 <br />