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'<— - – ___ - --- - , <br /> I � <br /> ! l��'iL�T� �'Efcdlfr��i I��"�'����iT���� � <br /> � CITY OF EVERETT PERMIT� SERVICES � <br /> i 3200 CEDAR STRLGl , EVEREII . `�VA 95201 <br /> 425-257-8810 - FAX425-257-885r -- vnrJw.everettwa.org � <br /> � ' <br /> � <br /> � l`/3/ 1o.� t3r.�rp --- -- <br /> j PRCJECT ADDRESS � <br /> ! ri e��.�„—�e_r ti�F���, 2S�- ���7 � <br /> --- -- — - ---- <br /> � PropeRy O�vner ��7aii Atltlress f,ty State�L.p Fhonc I <br /> � <br /> I Tenant Name Qf this is fcr a commercfal business) <br /> I �1/t� /�/k,2�j�n 4 -f�/G7 7�rm�a,�r rb. s✓ i�� w.S- 98z�a 7fi7 /So7 <br /> ' Conirac'cr �M1�tailAddress C�;9 Slate�Zp Pho�e � <br /> /' �liL��G /C 3L7 GS3 �/.f.S <br /> i <br /> '.'Ji:Sta'e Contraclor I.icer,se Diumber(required) City of Everelt 9usiness License N�mber (required) � <br /> ' Work to bc done: <br /> � �I <br /> ❑ Side Sewer Repair ', <br /> i ❑ Side Sewer Aitera!ion <br /> i <br /> ❑ Side Sewer — New Installation <br /> Install Backwater Valve (outside tiie building) <br /> I � I <br /> ❑ Cap off Sewer � <br /> I <br /> I <br /> ❑ Install Water Meter ---� I <br /> FEE <br /> -- � � a°� <br /> f�2 ��/.� PFRMIT# � I <br /> Signature Date � I � � I � / 1 ' <br /> --` --`�r—J <br /> FcVISED�t/fa201.t <br />