Laserfiche WebLink
UTILITY PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />PROJECT ADDRESS C 42 <br />A,^i V / State2Ip <br />Property Owner <br />rclail Address City <br />Tenant Name (If this is for a commercial business) <br />JQ CVQ2%I l iy q 90 <br />�tb3 zgr-L <br />�W City StalefZip Phone <br />Contractor Mad Addross <br />WA Stale Contractor 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 />"1L — 115 <br />Phone <br />City of Everett Business License Number (required) <br />FEE <br />3000 <br />PERMIT# <br />U (5o3-D57 <br />Revrsm 171197014 <br />