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 />7�t5 Md����. ,�_ <br />PROJECT ADDRESS <br />5�.��, �=����. <br />Property Owner <br />C. �c.�. `ti` � c.J� �l S�A') <br />� I I S— �/� � ru�.�n %-d . �✓G✓c-�' <br />Mail Address City <br />Tenant Name (If this is for a commercial business) <br />50� ��5�- ��u,..t(��. <br />z�o � S� A�sl�.. 5� <br />Contractor Mail Address <br />SUUT ��,.� t� QS -1 l C(o <br />WA State Contractor License Number (required) <br />Work to be done: <br />� Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer — New Installation <br />City <br />❑ Install Backwater Valve (outside the building) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />Date <br />REVISED 11/19/2014 <br />I,JI�- � g7� 3 <br />State/Zip Phone <br />��w-t�� , (�-��- ��lv(o Czo�)�3z- 1��7 <br />State/Zip Phone <br />U 3� 0 3v <br />City of Everett Business License Number (required) <br />FEE <br />�v�/�� <br />PERMIT# <br />U 15��-00� <br />