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r --." <br />�_ � �'d'VY,ep��� i�����P�V�' ,�V�W'����v 0���9 <br />��. <br /> C1TY �F EVERETT PERMI� S�RVIC;E� <br /> 3200 CEDAR STRGET, EVEP,[TT, WA 98201 <br /> 425-257-8810 - Fi1X 425-257-a857 -www.?verettwa.org <br /> %G t j p i)C f!r�'i l I' :2 <};��i �v rn ..r'rT <br /> PROJECT ADDRESS <br /> Nin��v..� 9�0�- �yU-�CB � <br /> Properiy Owner S7aJ Address C�ly State/Zip Phone <br /> 1 �U �- <br /> Tenant Narne(If this is for a commercial business) <br /> �,O!/ <br /> �4c,-*to P�„�.�a��� Po �nc ��i�C� 5�...�,�rM�c� wr- S���� "ldv D�z� <br /> Contrac�or �dad Address City State/Zip Phone <br /> ���''nPP�S��-N 1- 05333 � <br /> WA Stale Contractor License Number(required) City of Everett Business License Number(required) <br /> Work to be done: <br /> ❑ Side Sewer Repair <br /> ❑ Side Sewer Alferation <br /> ❑ Side Sewer- New Installation <br /> �lLstall I3ackwater Valve (outside the buildiny) <br /> ❑ Cap off Sewer <br /> ❑ Instali Water Nieter <br /> FEE O <br /> . ���� <br /> � � � 7 �� PERhiIT# <br /> —' gnatu�e ate � � �O�_��, / <br /> ..J <br /> aewseo r rnarzou <br />