Laserfiche WebLink
' �1TlLITY �ER�VIIT APPLICATION <br /> CI�"Y OF EVERETT PERMIT SEF�VICES <br /> 3200 CEDAR STREET, EVF_RETT, WA 9820? <br /> 425-257-8810 - FAX 425-257-8857 -www.everettwa.org <br /> •2�.�� 1 � ��C — — <br /> PROJECT ADDRESS <br /> __-_l�_���_— -- -r�i..�T w4- LfzS-ZS`z yCP�Y� <br /> Property Owner MaJ AAdress Cdy Stale/Zip Phone <br /> Tenanl Name Q(Ihis is for a commercial business) <br /> ��,�---y� � — <br /> �(�1 � b���R � � c ,P�i� �i�s��� �� ��� o rz�— <br /> ,,� <br /> 'Con�ractor Mail Ad ress City SlalelZip Phone <br /> �9-�/��//�.LS dS--7 S 5� <br /> WA Slate ontr ctor License Number(required) City of Everelt Business License Number(required) <br /> Work to be done: <br /> ❑ Side Sewer Repair <br /> � Side Sewer Alteration <br /> ❑ Side Sewer - New Installation <br /> f�Lttistali Backwater Valve (outside the building) <br /> ❑ Cap off Sewer <br /> ❑ Install Water Meter - -- --� <br /> FEE <br /> � 3oeQO_� <br /> - — � ���� .. �%� ��RMrrrr <br /> SignaWre ate <br /> U �50(�-0�1'Z <br /> ,,,:�,�<<�,,,,a��,.� <br />