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--- —1 <br /> UTILITY QERMIT APPLICAT�ON <br /> CITY OF EVE�RETI' PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 —www.everettwa.org <br /> ���t !�e Rp _ <br /> PROJECT AD ESS <br /> ��g-� _J.�k� � �,PP ►Rn k�rc�t u�a. yas 3a a 87o <br /> Pfoperty0wner MailAdtlress Cily Stale/Zip Phone <br /> ITenant Name(I(Ihis is for a commercial bus:�ess) yas �7g�$9 <br /> (���rn6s5 �.kw�ll�T��arr���,m[ 6Io� E�.�wi��a �✓� 98168 <br /> Coniraeto� Mail Address Clly Siate/Z�p Phone <br /> R�oR sc�aa bR ����ar� <br /> WA Slate CoNractor License Number(reqwred) Ciry of Everett Eusiness License Number(required) <br /> Work to be done: <br /> �Side Sewer Repair <br /> ❑ Side Sewer Alteration <br /> ❑ Side Sewer — New Installation <br /> ❑ Install Backwater Valve (outside ihe building) <br /> O Cap off Sewer <br /> ❑ Install Water Meter FEE � <br /> � 3D.°� l <br /> ��. I/7 ,� <br /> � � IZy 1'I�I� PERMIT# <br /> Signaturc Date ' I �IC/'yl J� �`�� <br /> lJ 7 !.� —� il <br /> I:E VICED 1 v1:DC�� _._____ <br />