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�, � Bc-• II \( ����0� J�����V.OG�V�tl�tlV <br /> l� � �{��� u <br /> CI5"�t' �)F �l�F�2E�s f��C�'6t�i�' ��E2�fIC�E� <br /> ;;200 CEDAR STRtET, EVERk?T, VVA 98201 <br /> 425-257-8�10 - FAX425-257-8857 —wv�nv.z��erett�va.org <br /> �31� �Loc�� Pk�1{/ P�t - <br /> PROJECT ADDRESS <br /> ��!'lJGtl W fl G��,�� <br /> Properiy O�vnei ��4ail Addr�ss City SlatelZip Phone <br /> Tenant Name Qf ihis rs for a wmmercial business) <br /> �y � � .�_ _S �/ 7 7/�.•'�zi✓�. MCiYSI/ �i� w/i �fs��.� 3,�s7�/S�7 <br /> /7 �v/��/ �'/Gc. �'i7=4 <br /> IContractor �tailFdtl�=ss - City State2p Phone <br /> /�PoGGi'� Q�3�i aS3�isr _ <br /> V��A State Contractor License Number(required) City of Everett dusiness license IJumber(required) <br /> Work to be done: <br /> i <br /> , ❑ Side Sewer Repair <br /> � <br /> � � <br /> ❑ Side Se�ver Alteration <br /> ❑ Side Sewer — Ne�v Installation <br /> � <br /> �Install Backwater Valve (ouisidc the building) <br /> � <br /> I <br /> ❑ Cap ofi Sewer � <br /> ❑ Install Water Meter FE� ' <br /> 3ooU . <br /> — � <br /> C _ �'071 - IS PERMIT,"� � <br /> . � Date � I� �(' ` I � � I <br /> Sigiawre <br /> J , <br /> REYISfD IIHSQOI< I <br /> ' I <br />