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. �1`TILI� P�RONII�' APPLIC�►TI06V <br />C�'�'lf OF EVE�E'fT PERMIT �ERVIC�S <br />3200 CEDAR STREET, EVERETi, WA 98201 <br />425-257=881� - FAX 4'15-257-8657 — www•everettwa.org <br />20 3 Z �/�., e. n i c.�. <br />PRUJECT ADDRESS <br />1 ac�n Q-QoAiS �n�� l/��4�wta. LL <br />Property Owner <br />Mail Address <br />Tenant Name (I( this is for a commercial business) <br />;�T��," �tl G, Cy2s ) L52 - LZ 5tf <br />�.ry ���p Phonu <br />Conlractar ManAaaross -••+ <br />/-� �tk.�� i 5�� G� 1, K t- <br />WA Slale CoMractor License Numher (reqwred) <br />Worlc to be done: <br />❑ Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer — New Installation <br />C� Install Backwater Valve outsi:;z the building) <br />❑ Cap oY Sewer <br />❑ Instali Water Meter <br />REVlSED III19/JO1d <br />�_3 � � `�v <br />City of Everetl Buslness License Number (reqwre� <br />5--rs- ls <br />PERMIT7t <br />l! 15os- o� I <br />