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� <br /> - � UTILITY PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8610 - FAX 42�-257-8857 — vsn�w.everettwa.org <br /> � l 3 0 Z � ra+�cQ ��-� <br /> PROJECT ADDRESS <br /> �O�n�'l C �r O n cc n � <br /> P�operty Owne� Mail Address Cit�� State/Zlp Phonc <br /> � �� <br /> Tenant Name (Il lhis is for a commercial business) �/�/„�Gb, <br /> �_/,J" 7�71� <br /> �� �vi�ll.a � ��c 3 4-�s G��r�w�� �I�b�FC� <br /> CoMractor Mail Address � C�ry IelZ�p Phone <br /> SC vw��L.c�'►�.,(o �'►'t s _ d � � ��fI <br /> WA Stale Contractor License Number(required) City ol Everett Business License Number(required) <br /> I <br /> Work to be done: <br /> O Side Sewer Repair <br /> ❑ Side Sewer Alteration <br /> ❑ Side Sewer - New Installalion <br /> �I Install Qackwater Valve (outside the building) <br /> i \ <br /> I <br /> ❑ Cap oH Sewer <br /> ❑ Install Water Meter � <br /> FEE <br /> � �D. o° <br /> ���/�� � 7�y`.�- PERMR# <br /> S�gnalure Dale 1 1 I � O�_ ��� <br /> U <br /> aEV�5E0�i��9?nu <br />