Laserfiche WebLink
UTILITY PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />L0 7 -� a,,,Jo AyE C-7/ • 9 80-Ao j <br />PROJECT ADDRESS <br />�$Zd3 y�s•a38-8657 <br />_7A-� ILI E gj1vcl/Ht/ S-L.0`� Sa.)vj "Z L�tJ�i7�� W� , �/as a3S 8667 <br />Property Owner Mail Address City State/Zip Phone <br />Tenant Name (If this is for a commercial business) <br />Contractor Mail Address City <br />C64 siyuy/pu PO 7/G 6 <br />WA Stale Contractor License Number (required) <br />Work to be done: <br />L 7Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer - New Insiallation <br />❑ Install Backwater Valve ;outside the building) <br />❑ Cap off Sep -r <br />❑ Install Water Meter <br />AP6- / 7 7 7 <br />Slate/Zip Phone <br />D 3 96 30 <br />City of Everett Business License Number (required) <br />_ ��000 <br />PERMIT# <br />Dale U 15 ps- o z� <br />REVIsco 11/19I1e14 <br />