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UTILITY PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EV[RETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br /> J�i27 �rLl��s Cu�� � ��cl �� Z.O� <br /> PROJECT ADDRESS <br /> � ►� � I < is <br /> Property Ov+ner Ma�l Address Cily Slate�Zip Fhone <br /> Tenant Name(If ihis is for a commercial business) <br /> �w� P b e( I �S ��� w� b_�? <br /> J <br /> Contractor h4a�iAddress C�ty State2p Phcne <br /> CAM�� B� ( � i � nals oy�� o3 <br /> WA State Con(�actor License Mumber(required) City of Everett Business License Number(required) <br /> Work to be done: <br /> ❑ Side Sewer Repair <br /> O Side Sewer Alteration <br /> ❑ Side Sewer - New Installation <br /> IC3 nstall Dackwater Valve (outside lhe huilding) <br /> ❑ Cap off Sewer <br /> ❑ Install Water Meter <br /> FEE <br /> �30, °° <br /> � s. 9 z �/�5 PERh11T� <br /> — S�9naNre �a�e I I I �h� � �jr,� <br /> �� V V�(� <br /> REVISED tfq9101: <br />, ` <br />