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�--- ------ — -- ---- --- _ <br /> . . ����,��� �L�3G�I�l�ll, �,���11������'��� <br /> �,�'��'oP �➢� i�°�0�9�fC��' �Ta��yz��J ��u��3��� <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 4?_5-257-8810 - FAX 425-257-8857 — Nrr,�v.everettwa.org <br /> � � � � �0� >>4,��1 �� cs���t� <br /> PROJECT ADDRESS <br /> �r � r^�i � .. f���-e�' <br /> PropertyO�.vner MailAddress . City State/Zip . Phone <br /> --�_ I <br /> Tenant Name pf this is for a commercial business) <br /> i <br /> a �1 e_l c 1 �:v�� ��t `Q t}. 55�f ► E,;����.� i.v� `�Ssu%(o <br /> Coniractor' y7ailAdtlress .� Ci!y State/7_ip Phon� I <br /> � � <br /> <'��"� �R� 1�1i� 1�S � u7 � � 5 � <br /> WA State CoNractor License Numbzr(required) City of Everett Business License Number(required) � <br /> I <br /> I <br /> Worlc 4o be done: � <br /> ❑ Side Sewer Repair <br /> ❑ Side Sewer Alteration <br /> ❑ Side Sewer— New Insialiation <br /> Install Backwater Valve (outside the building) <br /> ❑ Cap off Sewer <br /> i . <br /> ❑ Install Water Meter FEE <br /> �000 <br /> � ,� .-S�3/'Zo/s PERh7CT ' C- <br /> �aNre Da�e I�OS .- �� � <br /> � <br /> RCVISED I f/i91e01a <br />