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� I . � <br /> � UTILITY PERMIT APPLICATION <br /> ' CITY OF EVERETT PERMIT SERVICES � <br /> 3zoo �;i ��nf: � i E;i i � . � v� i:� i i , wn �3f3<<;i �� <br /> 42�i-?_57-P81U f l�X 41f� 7�i�i f�)f357 www.ever���fw;� ��i�� I <br /> I <br /> � <br /> i ly � � 3� T-�� ��; <br /> PROJECT ADDRESS <br /> �— ' ' <br /> ��-��+� - <br /> � � � ��-� � �-L��-__ ���� _ l�'� z 3�� <br /> PfOPeffy OWn2f Mail Address Ciry :;I,�I�r//qr !'honc <br /> Tenant Name Qf this is for a cornmercial business) <br /> �-� <br /> ; , _. , � , <br /> 1 _ � <br /> 1���`���'� �L�wV-����'CaIE;,� � x' 1 ��� ` E.' l ��'� �l �, , � _ �. ( ��C�, <br /> � c' i, c� � j <br /> �,--c,'c���� � a t�t�` 1� c'�� �� C�'1� ��'� <br /> -- - - ----_ <br /> Contractor Mail Address (:ity :;t,�I��/Jq� I/, �, -- I'lu�nc T_ <br /> I C � ��l� �J C., I �C �l <br /> 7 <br /> _� . .- <br /> �� i �=,`�,��' >�j`�=-� n� ��� Cr,-� �'/E.:, <br /> --- ------__ --- <br /> WA State Contractor License Nurnber(required) City of f verett l3usiness I_icense Number (required) <br /> Work to be done: � <br /> ❑ Side Sewer Repair I <br /> ❑ Side Sewer Alteration <br /> ❑ Side Sewer— New Installation <br /> 0 Install Backwater Valve (ouiside the building) <br /> ❑ Cap off Sewer � <br /> I <br /> I ❑ Install Water Meter �i <br /> I � � i I ,I <br /> �'�� c<> ( <br /> I � „� , <br /> ` � C` ,.; �' � � � I <br /> I -� - �� �" - C.� � <br /> � i _ �� � ,� 5 i�i i:r>> i �i � <br /> ;��;�,:,i����� � ,(,� � , <br /> � � � I!�C'�.� �' �'12 <br /> � <br />