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- _ - -- <br /> -- -- -- - -- <br /> - - --- ------� <br /> UTILITY PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 4?5-257-8810 - FAX 425-257-8857 -www.everetlwa.org <br /> U I SO6-by 6 <br /> . , � -�r -i5 <br /> 2 �I � 1N��rYi�Di'e_ ., Ev r-. <br /> PROJECT ADDRESS <br /> L-�E � � ��r � o� 1,3 I l.ut-�n�or5 FiU6 �VF, rL � l,�'� 4'Pa�1 <br /> PropCdy Owne� Mad�tldress C�ry StalelZlp Phone <br /> Tenant Name Qf this is for a commercial business) <br /> �a66��43� - ��a& i <br /> N .W SEixLiY Q!'a:v��A� FjTS5S7 3 �norF � i V�b l..�if1 ��IcS�l � <br /> CoN�ac�o� Mad AtlGress Cdy StalelZip Phone <br /> N w 5��,,SD �b3 P6 <br /> WA State Contractor License Num6er(required) City ol Everelt 6usiness License Number(requhed) <br /> Work to be done: <br /> C�" Side Sewer Repair <br /> ❑ Side Sewer Alteration <br /> ❑ Side Sewer - New Installation <br /> ❑ Install Backwater Valve (outside the building) <br /> O Cap off Sewer <br /> ❑ Install Water Meter FEE <br /> 30�' <br /> �,i,��L,-n---� K� r-_� b/ !I�/� PERMIT# <br /> SignaWre Q Date � I �O� � O�r <br /> Ip <br /> aEwsEDfmoRam — ---- <br />