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. <br /> . I ' r � � _ __ <br /> i�Y'V�..� � � ���i`�Y y �1iF�'��V�� � �� <br /> CITY OF EVERETT PERMIT SERVICES I <br /> j 3200 CEDAR S IREET, EVERETT, WA 98201 <br /> i 425-257-f3810 - Fr1X 47_5-?_57-8057 — �anv.everettwa org <br /> � 2 �o S -- �` �; �� �- �� � -- - <br /> PROJECT ADDRESS <br /> � -- __ _ ..---- --_ _ _ .__ _ -- -- --- <br /> Pfopr!�1yGvmer L1a,lA�Cre;s C'.� S:nIN17. Phono <br /> ' lenanl Naa'.e�I�!his�s!cr a�:on•n�,err,ial F.ininess) � �- -- - - __ . .-- ---- -- ---- <br /> � <br /> i �__�u.� /�.�..�1nn/� ( G �A�i/<i�.��.s� � /��'�o�.. .l�� ---�^$�,f`� '��'2 /,371�-6 <br /> Con�raetor I.fa��IFadmss G!y Slatell�p Phone <br /> .S�L✓��iG �7D i D �� 7 � y_ . -- — --- <br />� <br /> VL�Stafe Conlractor l�censr. Plumher(requ�retl) City of Everell Elusiness I icense Number(�r,quired) <br /> � <br /> i Work to be dnne: I <br /> I <br /> I ❑ Side Sewer Repair I <br /> I <br /> ❑ Side Sewer Alteration i <br /> � ❑ Side Sewer — New Installatian I <br /> ' I <br /> � � <br /> � H Install Dackwater Valve (outside the building) � <br /> � I <br /> I ❑ Cap off Sewer � <br /> i <br /> � <br /> � <br /> i ❑ Install Water Meter ---- -------- -- - ' <br /> FE[ j <br /> �D o0 <br /> , -- -- -- <br /> / � --- _ __ ---- <br /> �� -�—%_.. ��%� PeRr�n� <br /> L�--- <br /> Sigr,ature �� �— � I �O�� Y1�g <br /> �-- -----(J -- I <br /> � . ��� �oi�,�,.�;". _ . .. _. _ . .. _ .. _. _ . . _ <br />