Laserfiche WebLink
�`������� ' i���V�' ��''��C������ <br /> �I'�� �€� �06�RFi's ��'�t��{�" ��E�li6�E� <br /> 3200 CEDAR STREET, EVERETT, VI+A 98201 <br /> 425-257-8810 - FAX 425-257-8857 —���+w.everett�va.org <br /> �a-� Co�h� ��. <br /> PROJECT ADDRESS , <br /> E V t�f�C..'(r_'t i..�`� �brY+1 � <br /> Property Oe�ner fdail nddress Ciry S!ateiZip Phone <br /> Tenanl Name(If this is tor a commerciai business) <br /> �"f�c�i//� t'/t.�/�I3��9 5 �/'7 7�f�i°✓ui✓r.'-. Mc: ySv.I/G w!?' l�tS�7� 3`,�7�/S�7 <br /> v <br /> Conlracfor MailAddress � Ciry State2ip Phone <br /> /�f GG G PG �G.��%% GS3�/s-f <br /> WA State Contractor License Number(required) City of Everefl Business License Number(required) <br /> Work to be done: <br /> ❑ Side Sev✓er Repair <br /> ❑ Side Sewer Alteration <br /> ❑ Side Sewer — New Instailaiion <br /> J�Install Backwater Valve (outside the building) <br /> ❑ Cap off Sewer <br /> ❑ Install Water Meter <br /> FEE <br /> � 2 ��.�� _� <br /> , _ �- /✓ \� PERM7//T# I <br /> Signature �a�e I I I (�/�/ni'DI /n <br /> Cl b �VIV llv <br /> :�ewseo t visrt�fa <br />