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i_ - ___---- _ <br /> I - � <br /> I <br /> � � � �v UTILITY PERMI� APPLICATfON <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR Sl-REE1, �VERLTT, WA 98201 <br /> 425-257-8810 - �AX 425-2.57-8857 -www.everetiwa org <br /> `�°�'� � � `��� ������.:; ��—�' � 1,�-U`�= -'��� � "�' C� <br /> PROJECT ADDRESS <br /> �G�-��� �'��i,r;�� ---- --- �/z5�,��n:_�� � <br /> Pfopefty Ownef Mail Address City Stale/lip Phone <br /> �_._. <br /> Tenant Name (If this is for a commercial business) <br /> /��+�a.�� ('c-�u-5�`��c:i;c-;,��c�'i;:,,�C,� �E't> `�/ `�/t-ci�"!�S� �,b�-��, ���-�'r.�n�� G�=1� J'4°��� <br /> Contractor Mail Address City State/Zip �;.� Phone_ '`� <br /> ` �[..> '��j Z- ��t' � <br /> �� �%,���5�jr��;�hc i,� l���}/� 7 <br /> WA State Contractor License Number(required) City 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 /> Q Instali Backwater Valve (outside the buiiding) <br /> ❑ Cap off Sewer <br /> ❑ Install Water Meter <br /> F=Ee <br /> � ��' <br /> p ,� f `� �(�� , � <br /> � <br /> i � <br /> , - _ <br /> � r °� P <br /> '� - . i �.�-- _.. <br /> � I <br /> �� �� � <br /> . a :,, <br /> °�--_. ����' � '� �-.' �. _ 9__ /'`'�'`�_ - <br /> w--- � PCRMIT� <br /> ,_�� � <br /> - - ---- - <br /> i <br /> �.' Signafure -- - --- Uat`� ---1- ,, I <br /> � -- --- -- ' <br /> �-=� I�� ' �'�'� ' <br /> �_ -- <br /> � <br /> ACv�srD r7.-r9:�=c;- . <br />