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� 1 <br /> ' '. __ _ _. ' ._ _ ___ _ .___ __ .__. ._ _ ________ __ . _. _ . _ . _ _ .._ __. . ___ <br /> 'I � <br /> � f�Ti IL�T� �ERMI�' �PP�i�AT��f� ; <br /> � CITY OF EVERETT PERMIT SFRVICES � <br /> i 320U CEUAR STREET, EVGRET 1', WA 98"201 , <br /> 425-257-8810 - FAX 425-25i-8857 —vaww.everett�va.org <br /> I <br /> � I <br /> I /l 1 l G r,-.,-,� �-�..� ' <br /> I PROJECT ADDRESS � <br /> � �'�t �N,•�r�= Is �I ( i v-.,.,�� �rz F'�.tirr y'�z� � � <br /> IProperty Gvmer A7aii Address � City Sia�e2�p Phone , <br /> � I <br /> � Tenant Name (I(this is for a commercial business) � <br /> i <br /> I w r l G.�r'Sr L�..st f'o,3cx [`/9 ( n1e,,,��P �4'Z7 Z ' <br /> ! Conlract0� hta��lAddress Gty S!a'NT��p Phc�e �� <br /> � I <br /> („��l U G C c fS Y y L�•,� G `i Z`� 7ff � <br /> `P!A State ConiraUor License'Jumber(reauired) City of Everett Business License Number(required) ', <br /> Work to be done: � <br /> I <br /> ❑ Side Sewer Repair <br /> I I <br /> � ❑ Side Sew�r Alteration � <br /> I � <br /> I � <br /> i ❑ Side Sewer — New Installation i <br /> I � Install Backwater Valve (outside the building) <br /> ! I <br /> ❑ Cap off Sewer ' <br /> � I <br /> i ❑ Install Water Meter -- <br /> FEE <br /> i 3� � <br /> I L% - y (/ - ��S PERMr Citi— <br /> I Signature Daic � f�/� I � I � ""1_ <br /> I l. � (l- <br /> � I%ElvSEOfV�9i0fa — — _______ __"____."__ <br />