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, .. <br /> UTILYTI� fPER(�iIT i4�PLBCATION <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 /> � f5 <br /> -�' ��� �1 - - <br /> PROJECT ADDRESS <br /> ��1w `(�ov,c� 25Z1 �fi^Sk F�e,•e� (,JR �1`�Zd\ <br /> Properiy Owner Mail Address City SlatelZip Phone <br /> Tenant Name(If this is for a commerciai business) <br /> �,o:�o �cx��cr ; n(� 5�� TukW\k�.E�r„w3;o.��.\ �I,��l T�V.�al�. l��l� �1�5 � =���-c,.F � ,� <br /> Con�raClof MzilAddress Cily State/Zip Phone <br /> � Z- ��aq3o� ��� �a� . <br /> WA State Contractc;License Number(required) City of Everett Business License N�mber(required) <br /> Work to lie dorre: <br /> �. Side Sewsr Repair <br /> ❑ Side Sewer Alteratio�i <br /> ❑ Side Sewer - New Installation <br /> ❑ Install Backwater Valve (outside the building) <br /> , <br /> ❑ Cap off Sewer <br /> ❑ Install Water Meter <br /> FEE <br /> 3� `� <br /> G%l%'//" � �Z l- �5 PERMIT# <br /> alure �ate , 1 //—� ! � � f (,) <br /> U 7 I Y% l <br /> REVISEO f f/19ROla <br />