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,� <br /> ,�— __ <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 /> l�f'l�A D�'/�s�i� . �.ecu�— <br /> PROJCCT ADDRESS <br /> ��-�---��/.� D�r�S . --�-e�-�-y ��J - `75v -7�3 <br /> Property Ovricr IAail Adtlress C�ly SlateiLp phone I <br /> Tenant Narie(If this is(o� a commercial business) <br /> �v �/ Vlf �a-✓QO(il0. �f — <br /> �,Mh� �� c �v.e��c.� l��— 9r'�o� '�89-orz <br /> Conlractor ldad d ess C�ty State/Lp Phone <br /> �Pl�/,���rP� o>� ss-� <br /> 'NA�e Comractor license Number(requued) Ciry of Everett Business License Number(required) I <br /> Work to be done: <br /> ❑ Side Sewer Repair I <br /> � <br /> ❑ Side Sewer Alteration <br /> ❑ Side Sewer - New Installation <br /> nslall Cackwater Valve (outside the building) <br /> ❑ Cap off Sewer <br /> ❑ Install Water Meter ' <br /> FEE <br /> �30.��' <br /> �>� �—� /� � � PERMIT# <br /> Signature Dale � I� O � O�� <br /> REl'ISEO iV�9ROra � I <br /> — I <br /> � <br />