Laserfiche WebLink
- ---- - - l <br /> 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 /> T 1 �, I IZ ��c �� e � � v2 <br /> PROJECT ADDRESS <br /> —�1 ,,1,-�`,�. Ma� Leod ��3 � R �c�c� r A•Te G�PrP-�-1- <br /> Proper�y owner M1ia�l Address CAy Stale2lp Phone <br /> N I �- <br /> Tenanl Name(If this is 1or a commertial husiness) <br /> S�wer �'�- � P�C� �`I ��C �v 3oX 34� 5 Lyn � w�U�, w�- 98oU�o <br /> CoMfac�of Mail Address Cdy State/Zip Phone <br /> �o(n - b 96-74 78 <br /> Se•�e r �' I qic�M S o `-I�� � y� <br /> WA State Conlractor License Number (requiied) Cily of Everetl Business License Number(required) <br /> Work to be done: <br /> ❑ Side Sewer Repair <br /> O Side Sewer Alteration <br /> ❑ Side Sewer— New Installation <br /> �Install Backwater Valve (outside lhe building) <br /> ❑ Cap off Sewer <br /> ❑ Instail Water Meter <br /> r-Ee <br /> ��� <br /> � /� ) � � PERMITli <br /> SignaWre �ate � ��O Z _ ��` <br /> J .J <br /> REIISED 11/t940U <br /> ___ _---__-___ �` I <br />