Laserfiche WebLink
r <br /> WATER/SEWER 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.gov <br /> g�fl� �� i�� ��� � � �����_� c�.��� ��� 20�� <br /> PROJECT ADDRESS <br /> ��io� dlgt- ��r � L �������- wr� �� ����' <br /> Property Owner Mail Address City State/Zip Phone <br /> Tenant Name(If this is for a commercial business) <br /> o\ '�SC��e,. ��#�"r ��� -d� �p� �� 5��,������ 1��RC(�iC. �,�% V"� ���� � � <br /> Contractor Mail Address City State/Zip Phone <br /> � �" SGU� R� �; ���� � <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 /> �� �� <br /> � ` <br /> � " —r�' PERMIT# <br /> /�� . Date � I� I �/�� I <br /> REVISED 11/19/2014 <br />