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. . .r ' . - � _ . <br /> . � 11TILl"IrYY PERMIT APPLICATION � <br /> CITY OF EVERETT PERMIT SER�atCES <br /> 32p0 CEDAR STRFET; �/ERETT, WA 98201 • . <br /> . : " ' �425-25z-8810 = FI�X425-257-8857—www.eveiettwa.org <br /> 1 �y �_01�,� A�� <br /> PRAIECT ADDRESS . <br /> Ja�e� 0 '.`ec�ry � �2z. 3e�e��y f�ve. N.E lac�w.� `t84LZ <br /> � PropeRyOWner � � � MadAddixgs "C�1y � � . StaWZip' Phona - <br /> �4i.,v:k1,�o � . <br /> Tenant Name(If this i,tor a oommercial business) � � � - � � n'v_�^l�� <br /> L.lit�+-{ <br /> ;�� - �vi�.�,l�.� � �� �41 s l,�hr�yv� q�''�,,�� <br /> C�ntractor � . . . � �Mali Addmss'. � . - �CRy� . �c121p � � � Phone . — <br /> Sew�`�Lq'2.� ms b u �17�'-1 t-� <br /> WA S�ale Coatraciur Lia:nae Number(icyuifc� City of Evcrc&Business Lioen,e Number(mquirod) <br /> Work to be �nne• ' . � <br /> ,ti , <br /> Gl Side Sewer Repair ; • . <br /> ❑ Side Sewer Alteration . _ <br /> ❑ 5ide Sewcr— New lnstallation ' . <br /> �install Backwater Valve utside tho building) � . ; ' <br /> � <br /> U Cap off Sewer <br /> _ ,:: _ . <br /> � Insfall Water Meter ,. - �� <br /> FEF <br /> � _ jv�,� <br /> —,�/� r � i��'�-� PERMIT# <br /> . Signefute . . : - . D3te � ' ' .� (l O� ' O�J <br /> I✓ <br /> r�w3m rrns2oi�. <br />