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��'I�.B�� ����fi�IT' �F��LICATf�N <br /> C17Y �F F�/ERET'T PEFtMIT SERVICE� <br /> 3200 CEDAR STREET, EVERETT, VVA 98201 <br /> 425-257-8810 - FAX 425-257-8857 -www.everettwa.org <br /> �L�•✓�� �/f-in i� <br /> PROJECT ADDRESS <br /> � <br /> i e�� ,' e �3�f�r�.�i�� � <br /> Property Owner L%�ail Address Ciry State/Zip Phone I <br /> I <br /> � <br /> Tenant Name (If this is for a commercial business) <br /> /T/�G//Ci �%�.�✓�.� �n 9 5 �/ 7 7/�.��u .✓� .�-�a�y s v i i z w/i- ��S�7� 3 S.s7 r/So7_— <br /> � <br /> ContraCtor tdailAddress City StatelZ�p Phone <br /> /�fGG G PG �G.3�% OS3�/s-r <br /> WA Slale Coni2clor License Number(requ�red) City of Evereri 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 buiiding) <br /> ❑ Cap off Sewer <br /> ❑ Install Water Meter FEE� � <br /> � � o�� <br /> � --- ���fl�/.� PERMIT# �/ <br /> Signature Date � Ir^0�� ���( <br /> �� O <br /> Iq:1^SEO11/f9.^01< <br />