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. <br />I�TILlTI( P�IRMIi APPL�CATIOfV <br />�ITY OF'�VERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — �vww.everettwa.org <br />3ho� �i � � �v� <br />PROJECT ADDRESS <br />�U e. '��'t� tz� <br />Property Owner <br />Address <br />�n �= <br />i enant Name (If this is for a commercial business) <br />Conlracla� MaiiAddross <br />1� ;�1,k. �� i 5� �� � K� <br />WA Slate Contractor License Number (required) <br />Work to be done: <br />❑ Side Sewer Repair <br />0 Side Se�,ver Alteration <br />❑ Side Sewer — New Instaliation <br />f� F <br />City <br />i <br />E� Install Backwater Valve outside the building) <br />u Cap off Sewer <br />� Instail Water Meter <br />PENSEO t 1ns.�ala <br />City <br />c�c��) ;3�,g - f Soq <br />State2ip <br />(4 <br />State2�P <br />Phone <br />Phona <br />n�3ra�f8 <br />City of Everett Business License Number (requuad) <br />— � ' `.� PERMIT# <br />>ate U I 5� 3-� 1�- <br />