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. _ �J1'ILIT'� ��RNII�' APPLICAI'I�N <br /> Cll'�f AF EVERETT PERMIT SERVICE� <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 -www.everettwa.org <br /> L/I6 AlvrrsG� 13/�D <br /> PROJECTADDRESS <br /> !!a-//�Y rl/�'s _ <br /> Property OwnBf fdail Address City State/Zip Phonn <br /> r• <br /> Tenant Name Q(this is for a commercial business) <br /> �'%o/%}�,�1?�n� S '/�=7 7/j.Ir� i✓� r�a�rsv,�ie w!f- ���7�i 3�✓7—/S�7 <br /> Contractor tdailAddress City Stale2ip Phone <br /> /3/�oGGPG �3�7' oS3�iss <br /> WA State Coniractor License Number(required) City o(Everell Business l.icense Number(required) <br /> Work to be done: <br /> ❑ Side Sewer Repair <br /> ❑ Side Sewer Alteration <br /> ❑ Side Sewer - New installation <br /> �J.,Install [3ackwater Valve (outsicie thc building) <br /> ❑ Cap off Sewer <br /> f� install Water Meter -- - -- — ----- <br /> IEF <br /> �1� � � IJ�J <br /> - --- — ---- —- <br /> �/�3�/� _ �criMrru <br /> __ _-- — - — - - - - -- - - ------ I 11 <br /> Sic�naluro D�IP la 15D��D1� <br /> 1 � <br /> �n vr:i a i vw,�nr. <br />