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�9`�IL.I�'�" ��RM11' APPL�ICA�9�N <br /> CI'TY �F EVEREi'� PERMIT SERVICES <br /> 320D CEDAR STREET, EVERETT, VVA 982C1 <br /> 425-257-8810 - FAX425-257-8857—www.everettwa.org <br /> �-1 `bo3 �o\b,. �A.�e <br /> PROJECT ADDRESS <br /> �.V�'2� �n1f\ q�d�� <br /> Property Owner Mail Address Ciy StalelZip Phone <br /> Tenant Name Qf ihis is for a commercial business) <br /> �'!�o/%i f�%a��23 ir5 S �/'7 7/ri�z .✓� r�e. �v��i� w!�- �Ss�7� �.�7—/S�7 <br /> v <br />� Coniractof Nail Address � City , State2ip Phone <br /> i <br /> j /�'/��c G PG �03�r os3��s.f <br /> WA State Contraclor License Number(required) City 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 /> O Install Water Meter <br /> fEE <br /> , <br /> ��,p.�� <br />, _. �- lg—l� P[RMIT.'t <br />�7 Signature D�te I I � }^��� ^�O <br /> ll �'� (/ <br /> �errseo,v,o.za ra <br /> 1 <br />