Laserfiche WebLink
� <br /> IJTILITY P�I�IVIIT' APF�LICAT°IDIV <br /> CIT1f OF EVERETT PERMIT SERVICE� <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 —www.everettwa.org <br /> �a�� G �-d,�.�P ,�'� � <br /> PROJECT ADDRESS <br /> �j!/iC�'n/ �''6 / l B!' �'.� G <br /> Property0v+ner MailAddress . Gty . Slate/Zip Phone <br /> j��� Joy � s <br /> Tenanl Name(If this is for a commercial business) <br /> �'aw�nl��ll c Q � �cr��cn�t 'P� 55�t1 �„w;e� �� q$2Wo <br /> CoNr�— MailAddress � City Slate/Zip Phone <br /> <�dtl`� t�R+� 1`11`7 MS � y 7 � D � <br /> WA Stale Coniraclar License Num6er(reqwred) City of Everelt Business License Number(required) <br /> Work to be done: <br /> ❑ Side Sewer Repair <br /> ❑ Side Sewer Alteration <br /> � Side Sewer — New Installation <br /> �Install Backwater Valve (outside the building) <br /> ❑ Cap off Sewer <br /> ❑ Install Water Meter rEE <br /> �, ��p �oi <br /> �� � � � �/.�p/�,� PERMIT?f <br /> Signature Date � ��D� � l� � <br /> REVISPO f vioi1010 _ <br />