Laserfiche WebLink
- � • UTILITY PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8f357 —www.everettwa.org <br /> 3�y �c�Y ���E ����i <br /> PROJECT ADDRESS <br /> ' ?-��1 !�'h�,� �sr�l ��Y�� �.�r, �9A `r��l C�)Q��aP� <br /> Property Owner Mail Address Ciry State2ip Phone <br /> Tenant Name (I(this is for a commercial business) � <br /> /�2 � P�.�kar.Cl�r o�� S/(�b'��i�c� 1�' �`d"r�' (�76S1-�p�l� <br /> Conlractor MailAddress City Slate/Z�p Phone <br /> /���e�o��oaa��� n���o � <br /> WA State Contractor License Number(required) City of Everett Business License Number(required) <br /> � <br /> Work to be done: <br /> $� Side Sewer Repair <br /> I CI Side Sewer Alteraiion <br /> � Side Sewer— New Installation <br /> ❑ Install Backwater Valve (outside the building) <br /> ❑ Cap off Sewer <br /> ❑ Install Water Meter <br /> FEE <br /> '� �O a0 <br /> �,�� �O��b��ZO/5 PeRr�n; <br /> gna ure Date � 1�0�� (�� ^ <br /> 4 �� �/�� <br /> n_'V'SCO I I/191101� <br />