Laserfiche WebLink
WATER/SEWER 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.gov <br />� C�«`b rA / <br />� G.��' �( ( a � `g �-' "� t' �, � C' � C`c.. C-' <br />PROJECT ADDRESS �'�,�^l <br />J <br />(j - �"�I, f� C _ � r''�� � l�.-� � -��-vv�-c.i� �-�� �' � .:� � 1��, �G Z-`� � �, �� C.r :� �f, <br />Pfoperty Owner Mail Address City —�^ ' State/Zip Phone <br />.-��_-- '� <br />Tenant Name (If this is for a commercial business) <br />+-�-vVt�.n=Li G L�� �•'� % � �. ��`{ '�-�� <br />Z��% /'� c Bi � ? <br />�j{�. s y c.... C� ��; c�:- �`'-� � C "' -� � 7 � � C��'�''�� ��f �� . <br />Contra tor Mail Address City State/Zip Phone <br />� <br />%� �ti1�:i�t SS � � 'L 1�tL �;� � .`� �C � <br />WA State Contractor License Number (required) City of Everett Business License Number (required) <br />Work to be done: <br />CG�7�Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer - New Installation <br />❑ Install Backwater Valve (outside the building) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />�fi-����� <br />Date <br />REVISED 11/19/2014 <br />FEE <br />��jd ��/ <br />PERMIT# <br />U � -�� ���L �d�� <br />