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�;. <br /> :,, <br /> •� UTILITY PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 —ww��a.everetiwa.org <br /> I <br /> L�r g fZuc k�-z- c�v� �v�� ��. 9�Zv � <br /> PROJECTADDRESS ¢ZS 337 <br /> `I�l� wa4l.0 S l 0032 Z( 5'r !h UC� Ss L-�ee,�c' wr�. 98�8 ��� t <br /> PropertyOwner tda�lAtloress Cdy Slate/Zip Phone <br /> Tenant Name (If this is for a commercial business) <br /> Nc-r�o P(,�,� 3��� �'v �� �S� �o-�o� .c�� . �'8291 � �5'2q <br /> � CoNraCtor IAndlldtlress City Slate2p Phone <br /> �LYzp PPLg(,3Ns D5333S <br /> VJA State CoMractor License Number(required) City of[verett Business License Number(required) <br /> Work to be done: <br /> ❑ Side Sewer Repair <br /> ❑ Side Sewer Alteration <br /> ❑ Side Sewer — New Installation <br /> �Install Dackwater Valve (outside the building) <br /> � Cap off Sewer <br /> ❑ Install Water Meter <br /> FEE <br /> �JOac� <br /> S � � �� PERMIT# <br /> `-� SignaNre � — JDate ' � I �Or ! OO� <br /> 7 <br /> rrv15E0 I tn<2J'< � <br />