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r— .— — — - — -- -- <br /> � — — — -- — — — -- ----- — <br /> UTILITY PERMIT APPLICATION <br /> � CITY OF EVERETT PERMIT SERVICES <br /> 3200 CGDAR STREET, EVERETf, WA 98201 <br /> 425-?_57-8810 - FAX 425-257-8857 —www.everethva.org � _ '� —I $ <br /> � i �o �—o�� <br /> —1��--��c-�`,P- _ <br /> PROJECT ADURESS ( u25� <br /> ���v��C,�_l\os�1�.3_L���-�2_���� t�c�� z3s - �66 <br /> , f'roperty Ovmer �!an Adcress Gry 7 StaiNZip Plione <br /> Tenant Namc �If this is .'or a coirmercial 6usiness) <br /> �}`,`�e�;c�,i. (�{2�) <br /> s�,e_ �( s�`�le 5��2 2L�� L�,rz�r�c ��Z�C�J�U� G . <br /> Z-�y- 9�s 9 , <br /> Cor,rac!or R1ai�Aticress Crty Sta;e2o Phonc I <br /> �n�� 1 sSf'� I tLl� oS3��� <br /> LVA Sla;e Coniractor Lir.ense Num6er(required) Ciry of Everett�usness License Numbur(requued) I <br /> i Work to be done: � <br /> I <br /> � �Side Sewer Repair I <br /> i <br /> ❑ Side Sewer Alteration <br /> ii <br /> O Side Sewer — New Installation <br /> � ❑ Install Rackwater Vaive (o��tside the building) <br /> I <br /> I <br /> � ❑ Cap o(f Sewer <br /> � <br /> i ❑ Install Water Meter _ <br /> FEE <br /> �30 . � <br /> — —7= 1S PEar�rr;.- <br /> ' � �- Datc <br /> ,���,«o,, ,s,�,: <br /> u ;�� —o �� <br />