Laserfiche WebLink
UTILITY PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-881 D- FAX 425-257-8857 — wuvw.everettwa.org <br />�1 I �► c o I ti � /�-�- <br />PROJECT ADDRESS <br />Properry Owner <br />Maii Address <br />Tenant Name (If lhis is for a commercial business) <br />City <br />�oen I'�u��,br�� i7s�s y�`�sf. S� S�+�G,�. <br />Conlraclor MeilAddress City <br />mUen P(��.= $� 3 5 0 <br />WA State Contractor License Number (required) <br />Work to be done: <br />❑ Side Sewer Repair <br />O Side Sewer Alteration <br />❑ Side Sewer — New Installation <br />'�{ Install Backwater Valve (outside the building) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />REVISE011q9/101< <br />� <br />State2ip <br />�✓�1 ��rZ�a <br />Sfale2ip <br />Phone <br />,2 5 7t� & 3Go <br />Phono <br />053635 <br />City of Everett Business License Number (required) <br />:a�-_ � - � � - r �'. <br />30 p� <br />PERMCf# <br />Ui56(o-Ofo`% <br />