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� - -- --- -- _ _ -- -- - -� <br /> I- - ---- <br /> I V��Yf��`l�� �I��i��A�i � �I���,Il�,�,`�b��9 i <br /> � CITY OF EVERETT �ERMI�' SEFtVIC�� i <br /> I 37_CO C[DAI� STREET, EVEREI'T, WA 98201 � <br /> i425-757-8£310 - ;AX 425-257-8857 -v,n�nv.everethva.org <br /> � <br /> I <br /> � /5/ y ��..��1+-�rt � <br /> � PROJECT ADDRESS i <br /> � `> > �„ s � !��t� F_��, r/rc.�r� �i��o i _ � <br /> � R �.i'i � f� /_ /Y G-�r, <br /> P�opehy0�vner tfiadACtlress Gty State�Z��p P�one � <br /> Tenant Name Qf Ihis�s for a commercial business) ' <br /> I <br /> � <br /> ` � �k �tl � � l 2.0 % !3 7�1�t i I <br /> v��.l�.�.5 �, ,� ,. � lr r2����� � � <br /> ICon:racter P:tailACtlress City State�Z�p Phona I <br /> LI�F•���UECI �g�t �.l�'� � 5 �Z�t 7 � , <br /> 'A'A State CoMractor License flumber(required) City of Everelt Business License Number(required; i <br /> IWork to be done: • � <br /> I ! <br /> iO Side Se4ver Repair , <br /> � <br /> ❑ Side Sewer Alteration � <br /> i <br /> i <br /> ❑ Side Sewer - Ne�v Installalion i <br /> i <br /> �Install Dackwater Valve (outside tfie building) • i <br /> I ❑ Cap off Sewer j <br /> I <br /> ❑ Install Water Meter — -- I <br /> FEE � <br /> �7D ��a <br /> C/u� PEr�r�rr� <br /> — � —�-�, -s -- -- - , IS� � <br /> � U i�o� � <br /> �evseo,i;��,zo�+ <br />