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�T'��9`�� ���fifiV`� k��f�G�V�A�°0��➢ <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVER[TT, 4VA 98201 <br />425-257-8810 - FAX 425-257-8857 — Nnnv:.everettwa.org <br />/ L.�..� TY)�/�i <br />ti= ��- <br />PROJECTADDRES� <br />Property Ov:ner <br />�dail Address <br />Tenanl Name (If Ihis is (or a commerciai business) <br />CoNrac�or Mail nddress <br />wE� �F.��y�� <br />WA Stale Conlraclor License Number (required) <br />Work to be done: <br />� Side Sewer Repair <br />❑ Side Sewer Alteraiion <br />❑ Side Sewer — New Instailation <br />City <br />� Install Backwater Valve outside the building) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />(.c415ED t I/Ia:Jr1 <br />� <br />ciry <br />StalelZip <br />� <br />SlalelZip <br />Phone <br />Phone <br />o�y�a <br />City of Everetl �usiness License Number (required) <br />FEE <br />30� <br />PERMITtI <br />U IS�.�- p � I <br />