Laserfiche WebLink
UTILITY �ERMIT APPLICATION <br /> ClTY OF EVERFTT PERM17 SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 -www.everettwa.org <br /> I Cv"LZ l.D� �ar c� f-lu e �5v�2�— <br /> PROJECT ADDRESS <br /> (Ze, �,.� _ ct� �c�sc� 425 -Z39-S�St� <br /> Property Owner Mail Address C�ty Slale2ip Phone <br /> � <br /> Tenant Name Qf this is for a commerciat business) <br /> Car�-P��S F �,.,•.���i �• fk�0_-as�l 5�������5-�9-3z39`� <br /> Contractor Mail Address Cny State2ip Phone <br /> C�+�+P� �'Z 9/7 �,S � D��7D 3 <br /> WA Slate Contrador License Number(required) City of Everett 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 <br /> FEE <br /> 30 _ 00 <br /> � II/ZS PERMIT# <br /> Signalure �a�e 1 I �[,�//'D -r�-� <br /> V � <br /> REVISEO Ir/19ROIJ ' <br />