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UTILITY PERMIT APPLICATION <br /> CITY �F EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257=8810 - FAX 425-257-8857—www.everettwa.org <br /> y3zY �««« p� �-�� <br /> PROJECT ADDRESS <br /> Ic"rl'y .�.�a�,(Cf�hcxT� �y T��RGG � �vr/i 1'`� �e C� <br /> PropeAy ner IJI Address Ciry SlatelLp Phone <br /> Tenant Name(If this is for a commerciai business) <br /> � ,�►� Sv�� 7/�9� .�1,�G,/i����� �s--��isd� <br /> CoNreClor MailAdtlress Cily � SlalelZip Phone <br /> 1���.,.,lj.n��!��/� ��l�SS _ <br /> w �.�«:{- <br /> ate Contractor License Number(required) Ciry of Everett Business License Number(required) <br /> Work to be done: <br /> ❑ Side Sewer Repair <br /> ❑ Side Sewer Alteration • <br /> ❑ Side Sewer— New Installation <br /> 0 install Backwater Valve (outside the building) <br /> ❑ Cap off Sewer <br /> ❑ Install Water Meter FEE <br /> ao <br /> �3v -- <br /> ��/��� ���/� PERMLT# <br /> ignat Date � � ' r II_ A � ( / <br /> ��T ����l <br /> PEVISEO II/19/1011 <br />