Laserfiche WebLink
� <br /> -- _ - - - -- <br /> __- _ _ _-- -- - � <br /> � <br /> UTILiTY PERMIT APPLICATIQLN <br /> CITY OF EVERETT PERMI i SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 33201 <br /> 425-257-8810 - FAX 425-257-8857 —www.e�:erettwa.org <br /> 1 yl( �� .���-� ��� � <br /> PROJECT ADDRESS <br /> ��(//I/� C 4 e ��O(/ �J�d�� 4�� <br /> Pfoper�yOwner MailAddicss City Stale/Zip Phone <br /> Tenanl Name (If Ihis is for a commercial business) � <br /> <<-: <br /> CQ,y�6��1�� � ,� h�,� - <br /> Contrac�or 1 ail Address C�ry . State/Zip Phone <br /> ��,�P� p � q, 7 r�f a ��� o� <br /> WA Stale CoMractor License Num6er(required) Ci!y 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 F3ackwater Valve (outside the building) <br /> ❑ Cap off Sev�er <br /> ❑ Install Water Meter . ------ <br /> FFE <br /> ��f �� ��// /I' � � a� � �-�° , °�__ __ <br /> 4 Uv�^' � ✓ /�/`� PERMITtI <br /> —_ — — ---- — <br /> Signature Date 1 I I('�h� � {��1� <br /> U �J U U � <br /> Rf L'ILFU II/I9^rUFI <br />