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a��o�o� ���m��° �►���ac���o� <br />�8'6'1( OF �0/ER�TT �IERMB'� �ERV9CE� <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.evereriwa.org <br />/ �/ ) �� `i�n' ' `.' A�I � <br />PROJEC7ADDRESS <br />� <br />Pmperty Oemer <br />Mail Address <br />Tenant Name (if this is for a commercial business) <br />Cont2Cto� P�ailAddress <br />/� vlk.� ► 5� 6 � K� <br />WA State Contractor ��ense N,imher (required) <br />Work to be done: <br />❑ Side Se�ver Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer — New Installation <br />City <br />E7" Install Backwater Valve outside the building) <br />❑ Cap off Sewer <br />� Install Water Meter <br />RfV,Sm , inl�0�. <br />� <br />C�ry <br />C�{2,5� <br />1G, 25K— O��/� <br />Stat�p Phone <br />C��?S) <br />)0. C(�520� z�iti--ct�i5�1 <br />S���ip Phone <br />r��-i �i °� i l� <br />City of EvereU Buslness �cense Number (required) <br />-!5 <br />PERMIT# <br />U l 5o5-o�g <br />