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�`�ILIT'� I�ERMIT APPLICi4Tl�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 —wvvw.evereti�va.org <br /> �(gOsr C 1. � e. - e 98�111— <br />' PROJECT ADDRE S <br /> Property Owner Mail Address Ciry SlatefZ�p Phone <br /> Tenant Name (If this is for a commercial business) <br /> /T/�G//v fi ��7�/So7 <br /> �%u✓+I3 �o S�/7 7/ Ar� .,�� .�-�a�ysv,�i� w/,�- �fs�7� � <br /> Contractor ��lailAddress � City � State2ip Phone <br /> /�/��G G PL �03 GT aS3�/.s.f <br /> WA Slate Contreclor License Number(required) Ci�y of Everetl Business License Number(required) <br /> Work to be done: <br /> ❑ Side Sewer Repair <br /> O Side Sewer Alteration <br /> ❑ Side Sewer — New Installation <br /> �Install Backwater Valve (outside the building) <br /> ❑ Cap off Sewer <br /> ❑ Install Water Meter FEE <br /> I <br /> �v � <br /> __ PERMITA 1 � <br /> Signature Dale � � � r O �_ �� <br /> � <br /> RENSEO f i/19R014 <br />