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��'a�4�`� ����lII�' a4PPl.vl��,"fw01� <br />�Ilf�f C�F EVERETT PEf�MIT SEF��/ICE� <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-881� - FAX 425-257-8857 — www.everettwa.org <br />3�'�l ���� <br />PROJECT ADDRESS--� <br />Prop��rfy Owner <br />Mail Atldress <br />Tenant N2me (If this is for a commercial business) <br />/ e,�i�P '{\ �,I'�n ti �a <br />Contractor IJlail Address <br />��� F! ��� �c f_ 5��1 /,IM <br />VVA State Contraclor License Number (required) <br />Work to be done: <br />❑ Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer - New Installation <br />City <br />Install F3ackvdater Valvc (outside 1he building) <br />l'� -___ <br />❑ Cap off Sewer <br />❑ Install Waler Mc`.er <br />City <br />1>"6-7 /S -��ls <br />Statc/7ip Phonc <br />��io-P, (itJ� l ��7 �- <br />Stale2ip Phone <br />� � 2-`1 �8 <br />City o( Everelt Business License Number (required) <br />� �/�� /�c�S <br />� � � / <br />- -- ��' �� -�e - -- --------- — � Uate �t—_. <br />,:: ,,,;��,,,,��o„ <br />FEE----- � <br />� 3oao <br />������,�T,r — --- _ _ _ � <br />UlSo3-083 <br />� <br />