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— _ _ _ --- -- -- — — — - 1 <br /> ��'����'�� ����I�' a��f��.,l��,���� I <br /> I �isl3'�' �'�F E�'EFlE7�' i'EFdMP�' �E�V��E� � <br /> I 37_C� CL=DAR STREET, EVERETT, WA 98201 <br /> �25-257-F�810 - FAX 425-257-8857 — v✓ww.everettwa.org � <br /> � <br /> � i <br /> I <br /> 1�/I s' I�M r�,�� I <br /> PROJFCT ADDRES� � <br /> I <br /> �"G�✓G _Q �/,J/ lC�n '� <br /> Property Ovmer fa7a�i nddress C�t� S:ate2�p Phone <br /> I <br /> Tenant Name(If ihis is for a commercial busir,ess) � <br /> �'/�//�'i � <br /> � �/r.�✓iL7-�� S�/-%7 7/sA�� .�� r�a�ySv,iiz w/�- l��s��� 3.Ss7�/So7 i <br /> Conlrac;or G4aJAtldress Gty Slaro2ip Phone <br /> � /f/?o� C.�'G ,�'o.��j oS3�/s.r , <br /> � !��A State Contractor License Number(reGuired) Cily of Everett 9usiness License Number (required) I <br /> I ' <br /> II Work to be done: � <br /> � ❑ Side Sewer Repair <br /> i <br /> I <br /> ❑ Side Sewer Alteration � <br /> i <br /> ❑ Side Sewer - New Installation <br /> � � <br /> i �Install Backwater Valve (outside the building) <br /> 7 Cap off Sewer <br /> � <br /> ! ❑ Install Water Meter -- <br /> I FC-E � <br /> � I <br /> i �� � <br /> I <br /> I -- J�/Z����J PERMIT;t I <br /> Signature Date <br /> ; l� (r03� fa3 � <br /> � ��,-�s_a,,,,�,:�,_ � <br /> --- -- --- <br />