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i� ��0��`G�� i� i�ih���'�V`� ,A�'�'1LV��`7'd�i�9 <br />CITY C�F EVER�T":' P�RMI'Y' S�RVICI�,� <br />3200 CGDAR STREET, GVERETT, WA 98201 <br />425-257-8810 - FAX 425-?57-8857 - www.everethva.org <br />'/�ic7 rev��G/ A�� <br />PROJECT ADDRESS <br />J�nn,�P� S�/De�s <br />Property0wrer L1ailAtldress <br />Terant Name (I( this is fcr a commercial business) <br />City <br />State2ip <br />Phone <br />�l�Gi/U ��uiti3�na S�/o7 7lJ�A�G .�1� Mc.-r�S✓i/i� _Wtr���ki 3�7-/So% <br />ConUactor fda�l ilCdress C�ty Statr2ip Phone <br />fI/�oL/_PL 9G3GT <br />VJA Slate Cenfractor License Number (required) <br />Work to be done: <br />❑ Side Se�er Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer - New Instaliation <br />Q� Install Eia-kwater Valve (outside the building) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />�� <br />;% , <br />L� �__ <br />re <br />FECISeO 11/�9r01i <br />� <br />�S3 �/S.r _ <br />C:ty of Everet� �usiness License Number (required) <br />FEE <br />PERrirr� <br />� I,50Z -O�e � <br />