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U UTY PEER 0Tf APPLIMATM <br />UTY OF EVE e T PERMS T sFRV 2E-") <br />3200 CEDAR STREET, EVERETT, WA 08201 <br />425-257=8810 - FAX 425-257-8857 —wt J•everettwa.org <br />PROJECT ADCtRESS <br />,��r-1111 <br />3�,31 <br />Property Omail address <br />� commercial business) <br />Tenant Name (If this is for a <br />- Mal Address <br />City <br />Contractor <br />11VA State COntraci0r license Number (requred) <br />Woric to to he done' <br />❑ Side Semler Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer — New Installation <br />11 <br />I" Install Backwater Valve outside the building) <br />❑ Cap oll Eekgel <br />❑ Ins`all Water Meter <br />Signatr�fe <br />aEvrs® nnsw+r <br />(42-S) <br />Ci staterzip <br />rti�s> <br />':z'~ c <br />StatarGp <br />— J�bloL <br />Phone <br />Phone <br />City of Everett Business license Number (required) <br />�t J� 0o <br />JP '30, G�_� <br />