Laserfiche WebLink
UTILITIt' PERMIT APPL!CATION <br /> I CiTY C!F EVERETT PERMIT SERVICES � <br /> � 3200 CFDAR STREET, EVERETT, WA 98201 ! <br /> I 425-257-881U - FAX 425-257-8857 - www.everettwa.org <br /> � �3 `� v � Lvr�ba �� l�ve <br /> � <br /> PROJECT ADDRESS I <br /> � �.� �;���ter 5�..�,� �.���— y�2� 1 ( y�s� 7�`�7 <br /> e <br /> PropertyOvmer PdadAtldiess C�ry Slate/Zip Phone <br /> I <br /> Tenant Name Qf�his is for a commercial tus!ness) <br /> I SL�G��Ie VIGiIYI r PiUYYI��ny I <br /> Contractor ldal Address Q;y Stale2�p Phone <br /> � S{q-r-t � � 91Gc �� _ # Oy 1 i �f8 <br /> WA State Contrador License Number(reqmred) City of C-veretl Busmess License Number(required) <br /> iWork to bc done: <br /> ❑ Side Sewer Repair <br /> ❑ Side Sewer Alteration <br /> I <br /> O Side Sewer - New Installation <br /> � Install Backwaler Valve (outside the building) <br /> ❑ Cap off Sewer <br /> ❑ Instal� Water Nleter <br /> FEE <br /> , / �O oO <br /> „/ � \ �1�,. �' � -�� —Z��� PERh11T# <br /> Signature � Date ' I ' �O� � <br /> lJ <br /> REVISEo I r/f9R01a <br />