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������ ������ ��������A�� . <br /> �B`fi� �F �V/ER�TT P�RM94 �ERV��E� <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257=8810 - FAX 425-257-8657—www.everettwa.org <br /> 23 �2 � � we �`� ` <br /> PROJECi'ADORESS • ���J � <br /> 1, � �2 � T�, hC���� )L1Ci �15�.3 Z�- <br /> {� n.1��A �'`� Gr A !1J`Z ��Vl� tr��Lf�6�—� StatefGp Phone <br /> Property Ovmer Maii nddmss �'ry <br /> �f\l�f <br /> Tenanl Name(If this is for a commercial business) <br /> (�i?S) � <br /> �, C:iC> � C��:l+a� c(R, �11%`�.%�I,1 i,v . �[�5r,�0� �-iti�9.�i� G <br /> , C� S���P Phone <br /> Contractor MailAddress <br /> n �� � Y\ 1— /1ti� 1J 1 V <br /> �'�t �l�-� � �� City of Everett Buslness License Number(reqwre� <br /> WA State CoMractor Ucense Number(reqwred) <br /> Worlc to be done: <br /> ❑ Side Sewer Repair <br /> 0 Side Sewer Alteration <br /> ❑ Side Sewer— New Installation <br /> E( Install Backwater Valve outside the building) <br /> ❑ Cap off Sewer <br /> ❑ Install Water Meter FEE <br /> 30�� � <br /> j � — Z— �� PERMIT# <br /> �� i.(/� •_ oate � � �j f n '� � I <br /> Sig ahl. .�� <br /> �wsen nnsanf� . . <br />