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. . <br /> l� i��L�01�� pl�l��il�� ��I��BC��`��� i�]' <br /> � �B�Y �6� ��l�Rf��'� ���6��� S��dV9CL�� <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX425-257-8857—www.everettwa.org <br /> � 211 Z��Ihy <br /> PROJECT ADDRESS <br /> � � n <br /> � Fc.��_ <br /> PropertyOwner MaitAddress � Ciry State2ip Phone <br /> Tenant Name(If this is for a commercial business) <br /> ��,J2��IS �� �ttl�lrJtY1L� ��. � 'Jr�� �UP.�it'.�7 I�UCc IfS�IP <br /> Coniractor MailAddress City Slate2ip Phone <br /> �'�t� �l�� i`1 I7 i�� c'�+-I `17 � '� <br /> WA Stale Contractor License Number(required) Giy of Everett Business License Number(required) <br /> Work to be done: <br /> ❑ Side Sewer Repair <br /> ❑ Side Sewer Alteration <br /> ❑ Side Sewer— New Installation <br /> � Install Backwater Valve (outside the building) <br /> ❑ Cap off Sewer <br /> ❑ Install Water Meter <br /> FEE <br /> �O� <br /> ✓��2��,5 ��,�"n-�'t- 5����5 PERMIrT-�# �'�—y <br /> Signature � Date � I !�./��^ /1 X X <br /> ✓V ��c.�C� <br /> Fe�asen�vi onaia <br />