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��� <br /> 111'ILI� P�R�:�II" APPLICA�"�A�1 <br /> CiTY OF EVERETT PERMI'T SERVICGS <br /> 3200 (:[DAR STREET, EVERETT, WA 98201 <br /> 425-257-881 Q - FAX 425-257-8857 —wvw✓.everettwa.org <br /> � � �L� �� ����� � s�� � <br /> ,PROJECT ADDRESS <br /> ��1�� � ���1� ��Zu w��.,�- i�u��r wa � gr��� - � ��� <br /> —.--_— g��e7p Phona <br /> Property Ownef Mail Addmss �'ry <br /> t � <br /> Tenant Name (If this is for a commercial businessl <br /> C��� (`iz5) <br /> �S� . �,�c�� i �;�lt�� dA CV����i wa .i. -03 z������ts�t <br /> Contracror <br /> Meil Address City ilalafLip Phone <br /> �� �) �[J <br /> � �'illVl�.i ���6 l. K � _ —�= <br /> WA State Contractor L�cense Number(required) Ciiy oi Everett Business License Number(required) <br /> lNork to be done: <br /> ❑ Side Sewer Repair <br /> ❑ Si�^ S�wer Alteration <br /> Ci Side Sewer— New Installation <br /> Q" Install Backwater Valve (outside the building) I <br /> ❑ Cap off Sew���r <br /> ❑ Install Water Meter �E <br /> �jD°� <br /> = Z � ! L"' G.0 I � PEfU+TIT# <br /> Sig el .' <br /> oatc; U �li�V �i` V t�rri <br /> Ftv�seot+narzo�a --- —'� <br />