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i_ _. _.-- — .. _ -- ___—._- _ " ' <br /> I I <br /> UTILITY PERM�IT APPLICATION <br /> ' CITY OF EVERETT PERMIT SERVICES i <br /> 32C0 CFDAR STREET, EVERE7l�, WA 98201 <br /> ' 425-7_57-8810 - FAX 425-25;-885� -vnvw everett�va.org �� -D 3-�S <br /> I� U I j oa -ot��/ <br /> i <br /> ; Ll� !r �� e �� ��e <br /> I PROJECTADDRESS ���3 <br /> ;��wh � �v ��(��r v,�'cc`���� _ r.r�l� . �a74Y� <br /> Properly0wne� hlaiiAdaress Gry Sate�Zip Phonc <br /> � <br /> i <br /> � 7enant Name Qt ihis is(or a commercial business) I <br /> i � <br /> i �� �-� �j' �O� _ � � 9.�C�3`J �Y�U_✓_cx, �,n ZD�O �S�?`�(3( ' <br /> I Contreetor e�a�i tiearess c�ry Statr�7_�v Pno�e j <br /> � �{a� �s����� 4� q � �.����3 ; <br /> � `dJA S!ate Ccntractor Licensz Nmn6er (requ'�.retl) City cf Everetl �us�cess L�cense Number(requued) �. <br /> I <br /> I Work to be donc: <br /> j �ide Sewer Repair � <br /> I ❑ Side Sewer ��Iteration � <br /> I <br /> � � <br /> I ❑ Side Sewer — Ne�v Installation <br /> 1 <br /> � � <br /> CJ Install E3ackwater Valve (outside the building) i <br /> � <br /> O, Cap off Sewer I <br /> � <br /> ❑ Install Water Meter --- <br /> F[E <br /> �,D a D <br /> � � �- -- - I <br /> ,e � � 3 - (� PEar�rru i <br /> S�gnaturc — —— Uate � ��O� ` �'l <br /> �� U N <br /> ,1. I <br /> RE�TccD t�/+o^,J�: i <br />