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UTILITY PERMIT APPLICATION <br /> • ' CITY OF EVERETT PERMIT SERVICES <br /> 3200 C[DAR STREET, GVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 -www.everettwa.org <br /> .2��0 �/L�'rE//�i2 ��` , �tJC/�'TT G�1� � I�Z o/ <br /> PROJECT ADDRESS <br /> CfflZ/J �/;-i2 l'/�Of� ���o ��ac.L'�Fc'l/i7�.�r/f G�/�z. �J�s,9d�o/y.,rs-P7o oY.�s <br /> PropCrty OwnCr tda�l Address C:dy Sta1c/Z�p Phone <br /> Tenant Name pf this is for a commercial business) <br /> o,�N��� 2����� ay�/ S<� A/���-r Sc'�,- �.�- lz�� 93a- 1 :77 <br /> ContraCtor tdall Address City State2p Phone <br /> n <br /> c'���ourt/t,�Pa��c� � -3 9� �Q <br /> WA Slate Coniractor License Number(required) City of Everett Busfness License Number(required) <br /> i Work to be done: <br /> ide Sewer Repair <br /> ❑ Side Sewer Alteration <br /> I ❑ Side Sewer - New installation <br /> ❑ Install Backwater Valve (outside the building) <br /> i <br /> ❑ Cap off Sewer <br /> i <br /> � ❑ Instali Water M1Aeter � <br /> FEE O �fl <br /> � 3 <br /> � S �II`�U� 5 PERMIT# --- <br /> Signature � �a1e I 1 1�� _0� l <br /> lJ l <br /> IiFl95CD 11/19�^.otJ <br />