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UTILITY PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR S I RI I I I VI RI II WA 98201 <br /> 425-257-8810 - FAX 425 257 8857 www.everettwa.org <br /> /6 / ttc-u-3, T—i <br /> PROJECT ADDRESS <br /> ill-gAi5rz-1 as—g& -Do?? <br /> Property Owner Mail Address City State/Zip Phone <br /> Tenant Name(If this is for a commercial business) <br /> / 64 <br /> (76*- Tt -a7i0eV'JC4:?iliee> jC)3 /4"-1: 1065- (1,44V-61:riiit Of-Contractor <br /> - <br /> Contractor Mail Address City State/Zip — Phone, - <br /> 7'70 '2 <br /> 4ce 616).--t\t(iLD <br /> WA State Contractor License Number(required) City of Everett Business License Number(required) <br /> Work to be done: <br /> O Side Sewer Repair <br /> O Side Sewer Alteration <br /> O Side Sewer New Installation <br /> lErlitall Backwater Valve (outside the building) <br /> O Cap off Sewer <br /> O Install Water Meter <br /> 4 00 <br /> r3/ /15 <br /> II IZMI I <br /> signatilie <br /> U 1500 ' OVO <br />