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� ---- ——- ---- - -- --- _ — -- -- <br /> � <br /> � U i�Lil"Y �CRIVIi� �►���.V�:AT��f�ii ' <br /> � CITY OF EVERETT PERMIT SERVECES ' <br /> I 320C CEDAR STREET, EVERETT, WA 9820� I <br /> � 47_5-257-8810 - FAX 425-257-8857 -www.everet,�.va org � <br /> I <br /> I <br /> I � <br /> / y �G ���-�J �+� ' <br /> - , <br /> � PROJECT ADDRESS <br /> � 3 ; <br /> / �� « �.3'�c, ,,S ta-� /Y�� G�n..J f�t� _ r„�,�r_ �,,,�4. �,s 2� r i <br /> � Propedy Ovmer t�.tad ndd�ess Cdy State�Zip Phanc � <br /> � i <br /> I <br /> I Tenanl Name(If this is for a commerc'al business) ! <br /> I � <br /> ic� �-(c��sf ��„sf Pa�r iYs�f /��� ��� w�+ g�� 'L _ � <br /> � Con;rac�or (ta�lACcress C.:y State'Zip Pho'e ' <br /> I <br /> �t/C L i...6L c �Sf�/G a-, o S z �l �� _ , <br /> � S:�A Sta!e Contiactor L�cen;e Number(req�iredi City c(Everet!Busmess L��cense Number ;requ.rec) � <br /> i ' <br /> Work to be done: <br /> ❑ Side Sewer Repair � <br /> i <br /> � ❑ Side Sewer Alteration � <br /> I � <br /> � ❑ Side Sewer- New Instaliation � <br /> I ! <br /> � <br /> I <br /> j �4nstall 13ackwater Valve (outside the building) I <br /> � <br /> I ❑ Cap off Sewer � <br /> � � <br /> j <br /> ❑ Install Water Meter -- � <br /> FEE I I <br /> �'d �' I <br /> i ����¢'��`-- � - 7 7-/S� PERMITk I I <br /> Signature Datc I ' I ��n I � I � � I I <br /> �,J V <br /> r•ev;_m�r:�s�r;r: <br />