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" UTILITY PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> I 3200 CEDAR STREcT, EVERETT, WA 9H2O1 <br /> 425-257-8810 - FAX 425-257-8857 —www.everettwa.org <br /> l ��� {'l c�lle-t�ll�;� /�we. <br /> PROJECT ADDRESS ��j 3���7 9 <br /> <���-�' �� ���s;� Qu! �� I `�/�`� �aGi�-� ��-e.� -�u.t�����T Lt�A- <br /> Property Ov+ner IJa id ss Cdy Stale/Zip Phonc <br /> S ��� <br /> Tenanl Name pf this is/or a commercial business) <br /> � I ' ( � <br /> .jJ � � �u vNbl�14� 77�h�! ���v/�� l3� �P lU, �-JNv�i,u�� Ge/,� ���}7 <br /> � <br /> Cont ctor blad Atltlr ss � Ciry State2ip Phone <br /> ��'%��l�� Q�y� �2 �' l t 7`f� <br /> WA Slate Contra tor License Number(required) City of Everelt Business License Number (required) <br /> Work to be done: <br /> ❑ Side Sewer Repa�� <br /> ❑ Side Sewer Alteration <br /> ❑ Side Sewer — New Installation <br /> 1� Install [3ackwater Valve (outside the building) <br /> ❑ Cap off Sewer <br /> ❑ Install Water Meter <br /> FEE <br /> �G� �O <br /> ( ll / <br /> Cti�G�J�J�I�� ��I3( �� P[RMIT# <br /> Signalure Dale 1 ' <br /> � 15Uy- 65 � <br /> rEViSE��,ry����J <br />