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l -- <br /> , _ - ----- <br /> ����..��"�" ���f!l�6� �PP�I(���A�� <br /> CIYY U� E�IERE"t i a�RMll' SE�W�CE� <br /> 32G0 CEDAR STREET, EVERETT, UVA 9R201 <br /> 425-257-8810 - FAX 425-257-8857 —v.v�h�d.everei+.vda.org <br /> 1 i� � N�yr <br /> PROJECT ADDRESS <br /> � iz�lanr7 13r1��� <br /> Property Ov:ner Mail Address Ciry SlatelZip Phone <br /> Tenant Name (If this is for a commerci2l busine=s) . <br /> �/GI�U � J o <br /> 7 <br /> �%��.i+13 n� S �/'7 7� r'r� i✓� r�� rSv,ii� w!�- J��5�7� 3,Ss7� S 7 <br /> Conlractor Inail Address � - City State2ip Phooe <br /> /�/�oGGPG Qo3�r os3�rss <br /> VVA Stzte Contractor License Number(requir�d) City of Everett Business License Number (required) <br /> Wo;k to be done: <br /> I ❑ 5ide Sewer Repair <br /> O Side Sewer Alteration <br /> i ❑ Side �au�er — New Installation <br /> I <br /> � �Install Backvdater Valve (outside the building) <br /> I <br /> I ❑ Cap off Sewer <br /> ❑ Install Water Meter FE[ <br /> I � 30 � � <br /> , <br /> --- ��//G��'� PERh7IT.� ���111 <br /> Signature Date � I'�"�l �� j'1�� <br /> I `�� U <br /> ;�Et 6:01 NI9�9p1< � <br /> �- -.___ � _ - . -_-__-_ <br />