Laserfiche WebLink
� <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 />� 9z.� ��wG�a ����.� <br />PROJECT ADDRESS <br />1 �z � Nc�,�,�.� I�c.� �=�er��f <br />Property Owner Mail Address City State/Zip Phone <br />Tenant Name (If this is for a commercial business) <br />���- <br />�art; -,��,� lc� � 5"�' t�c�w Ju �+�:��� T��w� ll � �ti�7— y'f�ICo �', y2s � 7� 3� zZS <br />ContraCtor Mail Address City State/Zip Phone <br />� l'-� ��2-5L / 22 8 ,�, <br />WA State Contractor License Number (required) <br />Work to be done: <br />� Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer — New Instaliation <br />❑ Install Backwater Valve (outside the building) � <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />� �/ <br />Signature <br />REVISED 11/19/2014 <br />�, <br />d37�'Z�d <br />City of Everett Business License Number (required) <br />FEE � <br />�0 ,°a <br />PERMIT# <br />U lL�l����� <br />