Laserfiche WebLink
UTILITY PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - f=AX425-257-8857—vnn�w.everettwa.org <br /> /1/� /2c�ck�/ G,�G <br /> PROJECT P.DDRESS <br /> /�cc� B/GG s C�r�cr n <br /> Propedy 0v+ner h7ail nddress City SIatM2ip Phone <br /> Tenani Name (II this is for a commercial business) <br /> �i�ciio p/�rn�3 n� S�/c7 7�'9�c.+�c /'4rYSVr//G wA- Si'szz (�/z5)34�—if�7 <br /> Confractor MailAddress Cdy Slale/Zip Phone <br /> � AP��LGl�L �a3 L.' pS3 �/SS <br /> W�State Contraclor license Number(roquired) Cily o(C-verell�usiness License Number(required) <br /> Work to be done: <br /> ❑ Side Sewer Repair <br /> ❑ Side Sewer Alteration <br /> ❑ Side Sewer— New Installation <br /> [D�Inslall Backwater Valve (oulside the building) <br /> ❑ Cap off Sewer <br /> ❑ Install Water Meter -- <br /> FEE <br /> _ 3Do� <br /> ---- /�/G� /S PERM[TY <br /> Signalurc Ualc 1 1 I �O1 — O �� <br /> U I <br /> f.EVISfO Ii/19RON <br />