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� � ����� ��,�i��� �; ��� ��re������ <br />�9 n `� �?�_ ��`�i�E�"'� E�;��f��i�" ��k�'�rifd� s <br />3Z00 CEDAR STREET, EVERGTT, WA 98201 <br />4?5-7_57-8810 - FAX 425-257-8857 — �a��,nv.everett�va.org <br />c1�� �� V � f \d\\G� �� <br />PROJECT ADURESS <br />- -- � U2!-�"�,�__ �� �i 9�a ( <br />Pmperiy Ownef A4al Addiess City SIa�e2ip Phone <br />Tenanl Name (If this is for a commercial bnsiness) <br />� <br />�"%G/I� 1u.i+�� _� S�/,%7 %Isa✓2 Nc' Mr �yS b, i/G W!?- y'.�5�7ci �,�57'�5�7 . <br />CoNraclor MailAddress City Stalc2ip Phone <br />�f uL L /�G G.�� <br />1!�A State Contractor License Number (required) <br />Work to be done: <br />❑ Side Sev✓er Repair <br />❑ Side Sawer Alteration <br />❑ Side Sevder — Ne�v Installation <br />c�lnsiall Backvdater Valve (outside the building) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />— s�,r,:Jurc <br />���,-,�,�;,.:-„ <br />OS3 �/s.f <br />City of Everett Business I_icense Number (required) <br />--- 1 � � 0 �� <br />_. — .— __.__ _ —__.. . <br />�ldtc <br />FGG <br />�Q� <br />PERMII# � <br />U 150� - �� <br />