Laserfiche WebLink
UTILITY PERMIT APPLICATION <br />PROJECT ADDRESS <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 />S=�- <br />� � <br />2 ���/I �`�,rr �'�-' ���G �'' <br />Property Owner Mail Address City State/Zip Phone <br />Tenant Name (If this is for a commercial business) <br />5��- <br />�vx -,�cw+�.� lv �; ss r��kw uu .�y�c� ���,�w� 11 � �ti�7-- f f�i G; f; y2s � 7� �� zzs <br />Contractor Mail Address City State/Zip Phone <br />'� i-� ��SL � 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 Installation <br />❑ Install Backwater Valve (outside the building) � <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />Signature <br />REVISED f l/19/2014 <br />437�z� <br />City of Everett Business License Number (required) <br />�z1��1��� <br />Date <br />FEE <br />��0.�°� <br />PERMIT# <br />U ���2'(��� <br />