Laserfiche WebLink
� ��i�o�� ��Rnni� ����.rc��ion� <br /> f�IT�( �F EVEREl'T PERMIT SERVI�E� <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 — v�nvw.everettwa.org <br /> l6�6 i�o��.��'�.�1�. I�U�- <br /> PROJECT ADDRESS <br /> ( nn .�L:i�'� �l LS �S�- 3g2o <br /> Property Ovmer Iviail Address Cily State2ip Phone <br /> Tenant Name QFlhis is (or a commercial business) <br /> (��)�.�«P�S� G��,s�u��,��� 9�,.� Po !�X ����� l�✓1�,���, w� iP2�-� <br /> Contracto� Iv7adAddress � City Stale/Zip Phone <br /> IW F/_ I���c L`6��1 /,1�� � ��-`1 7�' - <br /> VVA Sla�e Contractor License Number(required) City of Everett Business License Number (requir2d) <br /> Work to be done: <br /> ❑ Side Sewer Repair <br /> ❑ Side Sewer Alteration <br /> ❑ Side Sewer - New Installation <br /> /� Install Backwater Valve (outside the building) <br /> `� <br /> ❑ Cap off Sewer <br /> ❑ Install Water Meter <br /> F[E <br /> � � 3 O "-° <br /> � <br /> V " � � �{�S Pear•irr� <br /> �g ature Date � I��� �O�O <br /> RENSfD 1f/IY'010 <br />