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------ - - --- -- � <br /> � � <br /> IJ�TILi�'3� ��RMIT AF'PLIC�4`fION � <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR SlREET, EVLRE7-i�, WA 98201 <br /> 425-257 8810 - 1=AX 425-?_57-8857 —vdww.everettwa.org <br /> 23 Z 6 ��� s��cc,�- F��� �°� ( <br /> PROJECT ADDRESS <br /> ZvG-91S-57o <br /> ��SH Sc.RAUA __ C 3 Z6 /i:� ��y��f� ltifJ 9�zd I 2��3 <br /> Property0wner h4allAtldr=ss City Slate2ip ?honc <br /> ITenanf tvame Qf Ihis is for a r,�mmerciai 6usiness) � <br /> I � <br /> � � <br /> i �"/�cUu J�%t�/+13�n� S�/�7 7/�l�� i✓c. MG�YSI/riiz w���7:i 3�7�/So7 <br /> I = <br /> ContraCto; IfailAddress Cily Sizte2ip Phone � <br /> I , <br /> i /�f�GLr'� 4o3�i oS3�iss ; <br /> t'dA Siate Contractor�i�=nse Number(required) City of Everetl Business License Number(required) ' <br /> I <br /> � I <br /> I <br /> � Work to be donc: i <br /> � ' <br /> i ❑ 5ide Sevrer Repair � <br /> i <br /> i <br /> ❑ Side Sewer Alteration ' <br /> I <br /> I <br /> I <br /> O Side Sevder — New Installation i <br /> ti�install Backvdater Valve ouiside the building) <br /> ❑ Cap off Sewer � <br /> � <br /> ❑ Install Water ��4eter � <br /> FEE <br /> �3c� ,6% I <br /> _. PERh11Tn � <br /> ---- c,�.ature Date v f�� V �D� I ' <br /> rz=��sco�v;s^�ia l� <br />