Laserfiche WebLink
UTILITY PE�MIT 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 /> S �-�-��_ <<�. <br /> � �o �( �(v�r s �}- ���- U � S�a 5 <br /> PROJECT ADDRESS <br /> V!�(i��� <br /> Property Owner Nlail Adtlress City State2�p Phone <br /> Tenant Name (If this is for a commercial business) <br /> � i �y <br /> �tn�(f��i �1S�Jr S �.5�/�� S+,L. tP.�.d-l.�c i,.,�.t. �C�f/SC� o�G .�i �Sg.s2 <br /> ConlraCtor Mail Address Cily Slate/Zip Phone <br /> �r��Go �- � �6�Sk z US .��Z- c/ ( <br /> WA Stale Contractor License Number(required) City of Everett Business License Number(required) <br /> Work to be done: <br /> L�Side Sewer Repair <br /> ❑ Side Sewer Alteration <br /> ❑ Side Sewer — New Installation <br /> ❑ Install Backwater Valve (outside the building) <br /> ❑ Cap oK Sewer <br /> ❑ Install Water Meter <br /> FEE <br /> � 30 00 <br /> �� S� � PERMIT# <br /> Sionalure Date � ��Or� 1 �� <br /> J l <br /> rz<<-:s�o��„a�o�< <br />