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 /> Zv C�� �� �l `>� �'� <br /> PROJECT ADDRESS �IZ S-Z�f��` <br /> �"' .? �P2Y' <br /> �-�(,�11,�� t3�-���1��� 3��z � ����`i1��.(; .,�� rn��r� 5�,��r 1� �(���7� <br /> Property Owner Mail Address City State/Zip Phone <br /> Tenant Name (If this is for a commercial business) <br /> �' SqUv�E' c.�� OW V�E �'� <br /> ContraCtor Mail Address City State/Zip Phone <br /> ��-� c:���c�\ �3 "��=12 `�J �Z �5��'1�v� <br /> WA State Contractor License Number(required) City of Everett 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 /> � Cap off Sewer f—o � � (cJd ►�-_ ��4 � � D 00 <br /> � <br /> � Install Water Meter �W (�p �- ., p �� � �g �f�� <br /> FEE <br /> �`�0 �- �� <br /> - l � �l� PERMIT# <br /> igna re Date <br /> � ��v�-oz <br /> REVISE 11 9/2014 <br />