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_ . u-�i�,i�� ���nni� �PP�ic,�-reon� <br /> CITY �F EVERETT PERMIT SEl2VICES <br /> 3200 CEDAR STRGET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 —www.everettwa.org <br /> � �io�v-FI �y,�A �'7�i�ol <br /> PROJECT ADDRE S <br /> Property Ownef A4ail Address Ciry StalelZip Phone <br /> Tenant Name (If this is for a commercial business) <br /> /�"/'G//ci f�%u✓�j3 � S �/�7 7l�ire. n/� rrc:�vSv�i/e�' w/i' �f5�7� 3.Ss7'�So7 <br /> Contr2ctor (Jlail Address � City SlaleZp Phone <br /> /�/�oG G i'G�03 G r oS3��s s — <br /> VVA State Coniractor License Number(required) City of Everett Business License Number(requin:d) <br /> Work to be done: <br /> ❑ Side Sewer Repair <br /> ❑ Side Se�ver Alteration <br /> ❑ Side Sewer — New Installation <br /> Q7�Install Backwater Valve (outside the building) <br /> ❑ Cap ofi Sewer <br /> ❑ Install Water Meter FEE <br /> �,-� �'� <br /> , <br /> PERMIT# <br /> Signature Date . <br /> U � �b�l � D°►l� <br /> ��,sEo,,,,o��,< <br />