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 /> / �i� /��/� �= <br /> PROJECT ADDRESS <br /> �- g7/ ` <br /> � le� Gr/���� e i9�,T�/�- ��2; w,4-��,��, s���� <br /> IProperty Owner tda�l Address C�ry State�Zip Phone <br /> Tenanl Name (If Ihis is for a commercial business) <br /> (�->> <br /> �4R AI„�,�a,`� L « 8��� U����--�v��u-� � � vz�� �{8y-crz3 <br /> CoNraclor � Ma�l Atldress C�ty SlatelZ�p Phone <br /> fFr4 h�l� L'� 0�� �� � S-/ S��a <br /> WA St2le Conlraclor License Number(required) City o(Everett Business License Number(required) <br /> IWork to be done: <br /> � Side Sewer Repair <br /> I ❑ Side Sewer Alteration <br /> � <br /> � Side Sewer— New Installation <br /> I nstall Backwater Valve (outside the building) <br /> ❑ Cap off Sewer <br /> ❑ Install Water Meter F[E <br /> 0 <br /> 300 <br /> /`!G v 3�j��,� PERMIT,Y <br /> ignature Date � I r ?1�_ O I r <br /> l :� l/ �✓ <br /> Rf:v�Scc n.ip:•,r, . _ _ _--_ <br />