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IJTILIT'�° P�RMIT APPLICATION <br />CIiY OF EVERETT PERMIT SERVICES <br />3200 CE7AR STREET, EVERETT, WA 98201 <br />425-257-8810 � FAX 425-257-8857 — wv✓w.everettwa.org <br />�ia(7 S� Cb,jL� s�f FJ2�c� � �,JA `1g,�nl _ <br />PROJECT ADDRESS <br />r � � <br />Property Owner ,4ai1 nddress <br />Tenant Name (If ihis is for a commerr,ial ousiness) <br />/T /�G//� / %t,�/�13� <br />CoNrador <br />Address <br />�f GG G /'G �G.� �T <br />WA Stale Contractor License Number (required) <br />Work to be done: <br />❑ Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer — New Installation <br />City <br />QB�Install Backwater Valve (outside the building) <br />❑ Cap off Sewer <br />❑ install Water Meter <br />Datc <br />ums�n ivisnoi< <br />ciry <br />v� <br />S,ate/Zip <br />Stale2ip <br />Phone <br />'y I <br />Phone <br />oS3��s.r <br />City of Everett �usiness License Number (required) <br />E-�[ <br />�, i 1� <br />/ V <br />PERMITH <br />U150y -O�j <br />