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�`,..��--./', " �.r <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.org <br /> ���o �� c��Gs <br /> PROJECT ADDRESS <br /> � �c%,� � cr�s�� �yi- s si -a� a- <br /> Pro ertv O�vner Mail Address City Statel"Cip Phone <br /> Tenant Name Q(this is lor a commercial business) <br /> �9-_����.�. 6 �� .�r=�i .�.�a., pd2o�'- ��'� -ol z <br /> Coniractor Mad Address Cdy StalelZip Phone <br /> �-��-���'o��PfS � ��.�5�� <br /> WA Stale Contraclor License Number(required) Ciry o Everelt Business License Number(required) <br /> Work to be done: <br /> ❑ Side Sewer Repair <br /> ❑ Side Sewer Alteration <br /> ❑ Side Sewer — New Installation <br /> nstall Backwater Vaive (outside the building) <br /> ❑ Cap off Sewer <br /> ❑ Install Waier Meter <br /> FEE <br /> � �jQ�°°i <br /> �—�°� —/b`� PFRM1Ttt <br /> --- ,gnalu�e Datc ' 1 I� O� <br /> � U J � � � •. <br /> nrVr'rD nnY;O re <br />