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. i .. --- ---- -- ---- --- - ----- <br /> i <br /> � �"���.V�'�' ��:�iiii�� ,h=��'�9.,��.�,�VD�iI <br /> CITY OF EVERET i f'ERMIII '�ERVICES ! <br /> 3200 CEDAR STREET, EVERETT, WA 98201 � <br /> I 425-257-8810 - f AX 425-257-8857 -vn�n•teverettv�a.org � <br /> � � <br /> I ��� l 1��� � <br /> � � _ , <br /> I PROJECT ADDRESS ' <br /> I �y� �Q /� �jj �7 i <br /> �"Tpm h,� f �i '��� '�17� ��1P/.e.�0 ��l " �-�''� ' <br /> �-- <br /> i Propert�ivner L'a��1,lCdress C.Iy State2�p Phore ' <br /> I I <br /> I <br /> � I <br /> i <br /> ', Tenant Name(It this is tor a commercial busness) i <br /> I � <br /> I I/�e�at�,��i �srt�'ric�t�����P ' �k t(��/ �' �� i _ l�i Z.D� 79 3 ��/y 1 <br /> I Conlracto� h7a�lAdCrezs C�;y State2p Phone <br /> � <br /> j ��F�I,�J�cL�g�tl�'� _ DS L�{ 7 � <br /> 'NA State CoMractor License Number (required) C�fy o`[verett Business License Number(requlred) � <br /> I ' <br /> IWork to be done: j <br /> i <br /> � ❑ Side Sewer Repair I <br /> I i <br /> � <br /> ❑ Side Sewer Alteration � <br /> I <br /> I � <br /> I I <br /> ❑ Side Sewer - Ne�v Installation <br /> I <br /> i <br /> � � <br /> i �Install E3ackvaater Valve (outside the building) � <br /> � <br /> I <br /> i ❑ Cap off Sewer I <br /> I I <br /> I <br /> � ❑ Install Water Meter -- — � <br /> � FEE <br /> i �� �� <br /> I �� S PERh1IT� <br /> � �r ��Dat -- -- � I" / OI � /S� � <br /> � <br /> — <br /> F[�95ED I1;IS^0N <br />