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__� <br />UTILITY PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-881C - F�X 425-257-8A57 - wv�nv everettwa.org <br />Z l5/ �� l� V'Q /') U � V� <br />PROJECTADDRESS <br />�on�Pl Lytt-ov, Zl o z Gr--U�cQ A�e (-'�GrC�ti, W�- <br />Property Owner Mad Address Cdy Sate2p Phone <br />N ( /�- <br />7enant Name pf Ih�s is lor a commercial tu,iness) <br />��WPr�'rivh��v LLC 1�0 1�� 34�s ��NrwuooPtGv,q �i$O`�G <br />Contracior Mad Address Cdy Statc2p Ph �e <br />2GCo � �C+�`i7� <br />`�PwrJ i� �Ilo M � <br />WA Stale Contrac;or License Number (required) <br />Work to be done: <br />❑ Side Sewer Repair <br />❑ Side Sewer Alteration <br />O Side Sewer — New Installation <br />� Install [iackwater Valve (outside the building) <br />❑ Cap off Se�ver <br />❑ Install Water Meter <br />� <br />REVISEO 1V�cr01J <br />�S �G._] � �i 4 <br />Cdy of Everetl Business License Num6er (requireJ) <br />FEE <br />3C�°° <br />PERn�n� <br />U I 5 c� 3— 023 <br />