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. " <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 —www.everettwa.org <br /> 0?704 dS� S-r- ��� 1f�4�d�( <br /> PROJECT ADDRESS <br /> �AY/�-� IrVI�'CO�tA1C� oT7(�(o1�� ��E�TI- W�F l�od?l <br /> Property Owner Mail Address <br /> City Slate2ip Phone <br /> Tenant Name pf this is for a wmmercial business) <br /> \O'.-��) <br /> I�.Q. � ' <br /> ��i�- c�OCO 5 l(���� ��i7� tc}h (���65 �5=3ro7 <br /> CONraC�of Mail Atldre,s Cily S�ate/Zip Phone <br /> ��o��oaa,�� 9��"0�o <br /> WA State Coniractor License Number(required; City of Everetl Business License Number(required) <br /> Work to be done: <br /> � Side Sewer Repair <br /> ❑ Side Sewer Alteration <br /> ❑ Side Sewer - New Installation <br /> ❑ Install Backwater Valve (outside the building) <br /> ❑ Cap off Sewer <br /> O Install Water Meter <br /> ree <br /> �^ 30°° <br /> ���c�— �� �o �oi <br /> U� 1 PERM1Tlt <br /> Si naWrc Datc <br /> ul�-Ilz - o� � <br /> REVISFO I I/19/JO1J <br />