Laserfiche WebLink
* � <br /> 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 /> 4�723 �-L�e� �vc: �'(i�Tr- �✓�t. %�2D� <br /> PROJECT ADDRESS <br /> �U214h�T(� S/C/�TlCly �4`�' 3`3 IS��.C��2DV� Ci Nw, s'd?4. r�.4. ���77 2a4-�¢'��/� <br /> Property Owner Mail Address City State/Zip Phone <br /> Tenant Name (If this is for a commercial business) <br /> �}a�i t�,���r.cs �282� D�,3 ur���s � �Nob4os�►��� w+�a , 9�29 0 2caG-�'o�-0�2 <br /> ContrBCtor Mail Address City State/Zip Phone <br /> ��3Yzo PPL-Sfo3 �J � 0�33 35 <br /> WA State Contractor License Number(required) City of Everett Business License Number(required) <br /> Work to be done: <br /> ❑ Side Sewer Repair <br /> ❑ Side Sewer Alteration <br /> � Side Sewer - New Installation <br /> ❑ Install Backwater Valve (outside the building) <br /> ❑ Cap off Sewer <br /> ❑ Install Water Meter <br /> FEE <br /> � �_ <br /> ` � �� �d�l g - /� PERMIT# <br /> Signature Date � 1 � `� — O� � <br /> � <br /> REVISED 11/19/2014 <br />