Laserfiche WebLink
� UTILITY PERMIT APPLICATION <br /> � CITY OF EVERETT PERMIT SERVICES <br /> ' 37_00 CF.DAR STR[ET, EVERETT, WA 98201 <br /> 425-257-8810 - f-AX 425-257-8857 - www everettwa org <br /> ; �,�ld l� G� I��� �u�� �� <br /> � PROJECT ADDRESS � <br /> i ��� � � <br /> ' �a��n���Y.� ����u)�(' � �-�I'��� ����F� ��t ��/� �J� � c���� '�� <br /> Prooerty Owner htad AdOress C�ty� SlatelZ�p Pnone i <br /> � � I <br /> �� `��J � �� /� � '7(`�. <br /> Tenan; Name (II Ihis �s fer a commercial busness) I <br /> i <br /> �e :� �1��,�1��, � � -���� � �' ''�, ' �,, ��� -��1� ������ ��� <br /> ConUac�o� Ma�lAdtlress Oty StateZip i,q.;7y// PhonG�� i <br /> 1'�� ( Y v� <br /> ��U� �.=L �iJ�G �. 0�� '�G� ( <br /> 'NA State Contractor License Number(required} Cily o1 E�erett Business License Number(required) i <br /> Work to be done: <br /> I <br /> ❑ Side Sewer Repair <br /> i <br /> i <br /> , i <br /> ❑ Side Sewer Alteration ! <br /> � � <br /> ❑ Side Sewer - New Installation I <br /> I <br /> C Install Backwaler Valve (outside the building) � <br /> I I <br /> I ❑ Cap off Sewer i <br /> i ❑ Install Water Meter , -I <br /> FEE <br /> �� . �_ � <br /> � � /� ` � <br /> , ,�'� 3U � � <br /> � �: i <br /> i' /� C — (1(lV / � <br /> i � � PERMTT# <br /> � Sig ture Date <br /> ( ��` � l �aZ- 0�5 <br /> i--.�Fwseo,,,,a zo,: <br />