Laserfiche WebLink
- -- -- -- - � <br /> � <br /> UTILITY PERMIT APFLIC�iTfL!`� <br /> � CITY OF EVERETT PEfeMIT �ER�✓ICE.S <br /> I 3200 CEDAR STREET, EVEF.:=TT, WA 98�01 <br /> 425-257-8810 - FAX 425-257-8857 - �w.n•� everettwa org <br /> � ��.� � (�0 M�e-,�z-� �rr �(/c�2a�"'f" v-^� _ ��Zo ( � <br /> PROJECT ADDRESS <br /> PfOperty OwnCf �d'dd Address Gty Slate/Zio Phone � <br /> I <br /> � i <br /> — — I <br /> Tenant Name Q(this is for a commercial business) � <br /> i <br /> TIbPL� \lJ.�+^^�j /N�e f� �Dk �� 5'r�0, c.-ts�- �'l�2�'( `Lo(��17(v-�'72c i <br /> � ContraCtor tvtad AtlCress City State2��a P�one I, <br /> �c,�2D Pw'LU�3�� �3 'i '�-" ' <br /> WA State Contractor License Number(required) City of Everett Business License Number (required) <br /> � <br /> Work to be done: <br /> ❑ Side Sewer Repair <br /> ❑ Side Sewer Alteration <br /> ❑ Side Sewer - New Installation I <br /> �nstall Backwater Valve (outside the building) <br /> ❑ Cap off Sewer <br /> I <br /> ❑ Install Water Meter <br /> FEE <br /> � 3�°° <br /> �r— 3 v �l:S�_ PERMIT� <br /> Signature� Date � I�O� _I �� <br /> ;:c-���sen r viscoia <br />