Laserfiche WebLink
� . <br />� . <br /> M <br />} UTILITY PERMIT APPL�CATION <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 /> (� (�`� �Dc..l�����,�,�-ce <br /> PROJECT ADDRESS ���) <br /> . <br /> �� � we� �,� 1 h 07 ���ce p ,� � ,�(7 Y1ih �f zol z�2-6��8 <br /> Property OWnef Mail Address Ciry 5'atefZip Phone <br /> N� <br /> Tenanl Name(If this is for a commercial business) <br /> (42S) <br /> � SS �,�o� L�a-l�h �la r�V��`Gi- wa Q��.o3 zy�,� �as9 <br /> ConlraCtor Mail Address City StatrlLip Phone <br /> � M���I � S�6 � K �— c�53 ��f3 _ <br /> WA State Contractor License Number(reqwred) City of Everetl Business License Numher(required) <br /> Work to be done: <br /> ❑ Side Sewer Repair <br /> ❑ Side Sewer Alteration <br /> ❑ Side Sewer— New Installation <br /> � Install Backwater Vaive outside the building) <br /> ❑ Cap off Sewer <br /> ❑ Instail Water Meter FeE <br /> � �O✓ <br /> I— J '"o��� S PERMIT�f <br /> Sig at o Dale � r �� (' D / r <br /> I ( I � <br /> FEYISED I I/14/M.d <br />