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. . . . �JT�ILI�� P�RIV�IT' 4�PPLI�ATIOIV <br /> CITY �F EVERE7Y PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, VVA 98201 <br /> 425-257-8810 - FAX 425-257-8857 —wvwd.everetlwa.org <br /> �3��- �;,�n s� . <br /> PROJECT ADDRESS <br /> ��1�'�' ,�� `P�2D l <br /> Property Owner h4ail Address Ciry State�Zip Pbone <br /> Tenant Name (If this is for a commercial business) <br /> i <br /> I <br /> �'/�o/%i }�%wnl3�i�� S�/._7 7/�A�� .+i�. r+<:�rsv,ii� w/�- �?4�7ri �,Ss7-/S�7 ! <br /> Contractor Wail Address � Clty State2�p Phone � <br /> /�/�oG G�G�o3 GT oS3��s.f <br /> WA Sta�e Contractor License Number(requued) City of Everett Business License Number(required) <br /> Work to be done: <br /> ❑ Side Sewer Repair <br /> ❑ Side Sewer Alteration <br /> ❑ Side Sewer — Ne�v Installation <br /> �Install Backwater Valve (outside the building) <br /> � Cap off Sewer <br /> G Install Water Meter FEE <br /> � 3De�� <br /> -- � - 1� ` I� PERMIT� <br /> Signature Date U I 505—U S� <br /> FEVISED f f/f92011 <br />