Laserfiche WebLink
' UTlLITY P�RMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-2:i7-8810 - FAX 425-257-8857 —www everetiwa.org <br /> 1114 (,d�r.�-rww►z� �w ��vcrl.�vT" <br /> PROJECT ADDRESS <br /> �s2� f �/�¢ GvET/v102G GV�'�Z�T7` w� � !gZ°�' <br /> Properly0wner MailAddress City Slate2ip Phone <br /> Tenant Name (If this is for a commercial business) <br /> n 2�� �� <br /> �E'�'LU P�(n�n �/�_CLC !"0 l�Ori ov°�7 Sr,o. WK , `I'�J2S'/ ���9 — <br /> CoMraC�or Mail Adtlress Cny Slate2�p Phone <br /> ��ze o PPC-S G 3 N 1 �5333 S <br /> WA Stale Contrac�or License Number(reot,ired) City of EvereU Business 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 /> O Cap off Sewer <br /> ❑ Install Water Meter --- <br /> FEE <br /> 41'„J�. � <br /> I <br /> � ���•�_ P[RM1Ttl ---�— <br /> SignaWrc —— -- — Date � I� O^ � 0�7// <br /> � I� <br /> �xEv�Scn�rn9rm�a <br />