Laserfiche WebLink
1�� <br /> �i�L��l� ��P�N11T i4PP�o�p►���i� � <br /> i CITY OF EVERETT PERMIT SERVICES ' <br /> 32C0 CEDAR STREET, EVERETT, WA 98201 I <br /> � 425-257-8810 - FAX 425-257-8857 —vw�nr�.everettwa.xg I <br /> I <br /> � A <br /> Z�I� (�jlVw�•�G. /TJC LJGIGS( 1..�� ��'�j� <br /> 'I PROJECTADDRESS <br /> JuJ�SG�^�...5 Zll(� (s,�uw,�j,o. f't,.c LJcic�' � L..)/� 941Z03 I <br /> IProperly0wner hladAddress Cdy � State/Zip Phor.e i <br /> i I <br /> � <br /> '� Tenant Name pf th�s is`or a comrrerc:al business) � <br /> I ''I � <br /> �o.�Y�nwcsT ��v+�b�,n�o 7.�{0� SW f+�S� 5}_ 5e1�1L � �� `i�l6�p � <br /> ICcn4acter 1.ta��lAddress Cey State!Z�p hone <br /> (zU�� 43Z• t't� j <br /> � So�-�'�. W P r�� 1 C�o 0 3�o3d <br /> � V/A Slale Contractor License N�nnber(required) Cdy of Everett Business Ucense Number(required) <br /> I <br /> I VVork to be done: � <br /> I <br /> � � Side Sewer Repair I <br /> � <br /> I ❑ Side Sewer Alteration <br /> � <br /> I ❑ Side Sewer — New Installation <br /> � ❑ Install E3ackwater Valve (outside the building) <br /> � <br /> i <br /> � ❑ Cap off Sewer , <br /> � <br /> I <br /> ❑ Install Water Meter FEE <br /> 'I �c 6-D � <br /> i / Z � l �� PERrirr� -_ <br /> � 'ignaLue Date 1 1 <br /> u ��d Z" 07.'� <br /> reviSEo NisqaN . _ _____---__ . <br />