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� UTILITY PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 —�wrw.everettwa.org <br /> �jZC� �,Jv1rv-Ctn /0`/-�, <br /> PROJECT ADDRESS <br /> ,� d�,� Ca SSw L, � � <br /> ProDerty Ownef Mail Address City State2ip Phone <br /> Tenant Name p(this is for a commercial business) <br /> �-}rl ��� Se�cvs �/�/L Z�7�1 CLIF�S�/� � %��C C'f1.�.t�.o /S�- lv.� <br /> ConlraCtor tdail Address City S;ate2ip Phone <br /> ��Z�Z �JzS• `9/E -�iY Z <br /> ST 21 GS. rqz5�3 �� ��36�`1 <br /> I VJA State Contractor License Number(required) Ciry o(Gverett Business License Number(repuired) <br /> I <br /> Work to be done: <br /> ❑ Side Sewer Repair <br /> �Side Sewer Alteration <br /> ❑ Side Sewer — New Installation <br /> I ❑ Install Backwater Valve (outside the building) ' <br /> I <br /> ❑ Cap off Sewer <br /> ❑ Install Water Meter F[E <br /> � '��' <br /> � �f� � _ '3 � - I � PERMITtI <br /> �� �r��v � <br /> Signatuie Date � ��O`Z� I / /�, <br /> :� l�'� <br /> FEV�S[0!r��9.:Ji� __'_"__ _ .._ _-" -"-_ -- ______--_ <br />