Laserfiche WebLink
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 /> �s'!o C'�_ <br /> PROJEC'f ADDRESS <br /> � PVPr � �iPl�.� 171(o k���-kPr �vr� t;-4_ _�A 4z5 -3��j -7Z � <br /> PropertyOwner -� MadAddress GIy Siale/Zip Phone <br /> Tenant Name (If lhis is for a commercial business) <br /> ,���U�� F,r� E' ►�t c� �v ��G ��o ��u��c. ���� � 5 L.� n n w�>a�.P, wA q�i0 �l - <br /> COn�r3C10f Mail Addr ss CAy �State2lp 2C,�O _ VP�o U '7 `{ � � <br /> O I <br /> .Sc��v-cr F � �11�- �� S � �� � ��y <br /> VJA State Con(rattor L�cense Number(required) City of Everelt Busmess License Number(required) <br /> Work to be done: <br /> ❑ Side Sewer Repair <br /> ❑ Side Sewer Alteraiion <br /> ❑ Side Sewer — New Installation <br />� J� Install Backwater Valve (outside the building) <br /> ( <br /> O Cap off Sewer <br /> ❑ Install Water Meter <br /> FEE <br /> �D `� <br /> �� I Z/��1� � PERMIT# <br /> Signature Date � /�/ 7_ ��� <br /> ( L� <br /> REVISED I f/19?OII <br />