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�--•- - --- - --- -- --- - <br /> � ����1�� ��,���A� ��'����l.�A���� <br /> CITY OF EVERETT PERMIT SERV�CES <br /> 3200 CEDAF; STREET, tVERETT, WA 987_01 <br /> 425-257-8810 - FAX 425-257-8857 - wv�nv.everettwa-org <br /> I i <br /> ; �� 3 � l��-��� /� <br /> I <br /> I PROJECT ADDRESS <br /> � <br /> I wi� �1c1i-s 1�3c� ,���'� G�v�!'e� G✓�, j�Za-6 yzs-33y - ,2I3c <br /> wperty 0� h1a�l Address Cdy StatelLp Phone <br /> � � <br /> � Tenant �Jame Qf this �s for a commercial business) I <br /> I <br /> I ��,.r,.od�//s ��MS��G ?G, �3 ok 5svi L�v�� �k yPZoG v2f �aS'7-3��r S' i <br /> Contract0� FAail Addr=_ss City StateiZ�p Phor.e � <br /> I � <br /> iCG,., ,�s�; �s �`� --� �" �r ,� <br /> �� !^JA State Contractor License Number(required) Cily o(Everett Business License IJumber(required) <br /> � <br /> Work to be done: I <br /> � <br /> ! ❑ Side Sewer Repair <br /> � <br /> I ❑ Side Sewer Alteration <br /> ❑ Side Sewer - New install_tion <br /> f9'Install [3ackwater Valve (outside the building) <br /> I <br /> ❑ Cap off Sewer <br /> ❑ Install Water Meter — � <br /> FEE I <br /> �70 06 ' <br /> 1 <br /> !/�i�`�""1 L ���� � r � � I / } PERMIT� - / <br /> Signature �ale � IG/1 �_DS ! <br /> � /J(J <br /> �l'i5c'D f f/1940N — — "__ __ \ <br /> � <br /> � ^ ' � <br />