Laserfiche WebLink
�I I <br /> •� . <br /> � UTILITY PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES � <br /> 3200 CEDAR STREET, EVERETT, WA 9s2o1 I <br /> 425-257-8810 - FAX 425-257-8857 —v✓ww.everellwa.org I <br /> � � �� � p' S -a�- i5' ! <br /> C 1oy � <br /> PROJECT ADDRESS <br /> L4x� <br /> ' c Ilo�i�.,�ll� AVr Evr Wxq�Q-1-- <br /> Propet�y Owne tda0 Addre,s C�ry StalelZ�p �hune <br /> yss��-� <br /> , <br /> - , <br /> Tenanl Name pl lnis 5 lor a cummercial bwinessJ <br /> mQ.RocscEi� 2� s ub�*sr4 ��1t. �JA_��b� io�7J�o�i <br /> CoNraC�Or !da�IFCdress Gity State2ip phone <br /> _d__�tRoo�o2zNE �8�o I <br /> WA Sfate Cor.traclor I.icense Numhrr (reqwred� C0y cf Gveretl 6usiness Ucense Number(reqwred) I <br /> Wo�k to be do��: CI�.�U'I��� am��rao�'��� <br /> ' 6/ Side Sewer Repair <br /> O Side Sewer Alterat�on <br /> O Side Sewer— New Installation <br /> V he bull in <br />' L7 Install Backwater alve (outside t d g) <br /> ❑ Cap off Sewer � <br /> ❑ Install Water Meter <br /> FEE <br /> �fi30.00 <br /> �p2 �� P[RMTf# <br /> j Signa ure Dale 1 1 1 r� �/_ I /1 �- <br /> u 1✓\ V\ // _ <br /> ✓ J u0 <br /> PEV3CO 11;f990N <br /> i.i :a6ed L58�L5z52hT :ol :WOJd Ob�bT Si92-�c�-AtJW <br />