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_---� <br /> UTILITY 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.ory <br /> I U��6Z6� a� 0 �ll�� . <br /> PROJECT ADDRESS <br /> �i� } 2 �Z �o ��—__����ANo �v� ya5-a.5'�,0�� <br /> Property Owner Maii Atldress Cny S�alelZip Phone <br /> Tenant Name(If this is for a commercial business) � /� <br /> �. �� J� yrJ �7 <br /> CH��Ns o a� c... c� v(3fi ivw�� �R��i� .SI�lcr��.s� �✓� <br /> ,� � .�.�G 931 7 7 �,� <br /> CcnIrBC�or Mail Address Cily Slale2ip Phone <br /> NG✓S�t.�.s �863 P 6 ����V y <br /> WA Stale Contractor License Number(required) Ciry of Everell Dusiness License Number(required) <br /> Work to be do : <br /> Side Sewer Repair <br /> ❑ Side Se��✓er Alteration <br /> ❑ Side Sewer - New Inslallation <br /> ❑ Install Backwater Valve (oulside the building) � <br /> ❑ Cap off Sewer <br /> ❑ Install Water Meter <br /> FEE <br /> � .`� 30 �06 <br /> � � Cj � I S PERMff# _ <br /> Signaiurc Datc � f�o I _ A�� <br /> l l ll 1 <br /> REV4E0�Vf9?OIJ <br />