Laserfiche WebLink
--- — -- ---- I <br /> � TILITY PERNBIT APPLICATION ' <br /> U <br /> CITY OF EVERETT PERMIT SEFcVICES i <br /> 3200 CEDAR STREET, EVERETT, WA 98201 i <br /> 425-257-8810 - FAX 425-257-8857 —www.everettwa.org i <br /> i <br /> � � �� (or�bi9✓'� <br /> PROJECT ADDRESS <br /> JG.L�� V�e-A,�n /8/% /irn�tird �r/°�`-! � /�72p-6 './Z 3--.3,`�v.J�/�!/ <br /> °roperty Owner Mail Address C�ty Stale/Zip ?r.one I <br /> I <br /> I <br /> Tenant Name Qf lhis is for� commercial business) <br /> (iAMp�e�l5 �GUM�-^�. �0 gDk .SS��� fv�lC1� 9��0.� `/15 o�.S�''! '.3d'�2$ 1 <br /> CoNractor A4ailAddress , Ciry State2p - Phone� <br /> C��M�r3��y 9�7�'Lis �#o���� <br /> WA Stale Contraclor License Number(required) Ciry 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 FEE <br /> -�vv <br /> I ��(/UG�,-,-- � h��"" _ � / � PERMIT# <br /> Si9nature ate . � I 5.0 I ' , <br /> i <br /> i <br />