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. <br /> ����0�� �� r��l A� �,��'�-,�������� <br /> C6T`�( �➢F �V�F��T�' 6A�RMi��' ��G��,✓BCI�� <br /> 3?.OD C[DAR STRFFT, [VERET7, WA 98201 <br /> 4?_5-257-8810 - FAX 425-?57-8857 — www.everettwa org <br /> � I( G/ C G(�t'l��?/i .-- -- <br /> PROJECT ADDRESS <br /> � � � <br /> , /� <br /> ,�i[�(/" �— —�-�r ----- —----- --- --------- ---- -- <br /> Pwperty Owner ldaii Address Cdy State2�p Pl+one <br /> ITenaN Name(II this �s (or a commercial busmess) ' �� <br /> i <br /> a 1�e_IL.t_�_�,��id� �d 55�f � E�re� �� 9�2�(0 — <br /> Contrar,tor Mad Aatlress � Ciry Statc2p Phone <br /> �+� I� I� tv1S o _y � 7 �� - -- - <br /> WA State Contractor License Number(requued) C�ly of Evereri Dusmess License Number(reqdued) <br /> Work to be done: <br /> ❑ Side Sewer Repair <br /> ❑ Side Sewc:r Alteration <br /> I ❑ Side Sewer — �lew Installation ' <br /> � Install Backwater Valve (outsicie ihe building) <br /> ❑ Cap off Sewcr <br /> ❑ Install Water Meter ---- <br /> FEE <br /> , �._- , c �j C��. <br /> _ "'T'� � � ___--_���/�-- --- P[RMIT/f <br /> Signature Dale ' U I S�/ ' I C�� <br /> nfrrsro i vivzoia <br />