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�-- -- -- - ---- - --� <br /> ��'I�I'�"� ��RI��I�' �,�PL,IC�,'�"�t�NV <br /> �I�`t �F EVERETT F'�RMIT SEF��/4�;E� <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 —wwv✓.everettvda.org <br /> I 5� 2 �� ��- _ <br /> PROJECT ADDRESS <br /> � �L�s,�u'�����--- <br /> Property O�vner ��:all�1Cdress City Statc?_��p Phone <br /> lenar.t �'vame Qf;his is for a commercal 6usmess) <br /> �/Ji,�(I�P,S� llinSTtic �ri'�rn - � p� �X �y!� ����i�lo-P (itlZl l ��7 ��— <br /> Cont�acto� MaJ ACdress � City StalelZip Phone <br /> �/'J �� �,�.��.0 �._���t ���'� � �i Z`t �� <br /> I `'JA Slate Contractor License Number (required) City of Everett Business License Number (required) <br /> Work to be done: <br /> I � Side Sewer Repair <br /> ❑ Side Sewer Alteration <br /> I ❑ 5ide Sewer — New Installation <br /> ;] Install Backwater Valve (oulside the building) <br /> ✓� <br /> ❑ Cap off Sewer <br /> I ❑ Install Water Meter <br /> F[E <br /> � � 30� <br /> 7 <br /> ��✓ � I� IS PERh11T�t <br /> �, ature Date ' p I ��� � O C7 O <br /> E./ C( O <br /> �:n,su�,n.,,:v�� <br />