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�JTiLIiY P'�Rt1�li AP6�L.ICA.TIO�J <br />CliY �F EVERETT PE.RMIT SERVICE� <br />3200 CEDAR STREET, EVERETr, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />� �-�ou�- <br />PROJECT ADDRESS <br />e <br />O�mer <br />Pdail Addmss <br />Tenant Name (If this Is tor a commercial business) <br />ConlfactOf MailAddress <br />City <br />/� i���Z � ���� 1 K i- - <br />WA State Contractor �icense Num6er (required) <br />UIlork to be done: <br />❑ Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer — New Installation <br />E7 Install Backwater Valve outside the building) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />aEv�sen �insnaia <br />CiTy <br />-27 -- <br />C4�z5) <br />t�l z5z— 6/7£3 <br />StaleZp Phone <br />�`���'% <br />)A � Ct��3 2�-i�i,--ci�;5�1 <br />5���;P Phone <br />��3 �� �(8 <br />City of Everett Business License Nurr�ber (reqwre� <br />FEE �p6 <br />� <br />pERMIT# <br />u15����zr <br />