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CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />9 1,.i/p L. i✓ v,. 7 ir�r�cr C- V r ,�1 r <br />PROJECT ADDRESS <br />MtcI4A,t:L 172-¢ 6v�-&" (,ve✓(--rT tN`' . -�Zi-1 - Z5 <br />Property Owner Mail Address City StalelZiD Phone <br />Tenant Name (if this is for a commercial business) <br />Ht-Y,0 PI j A 3,.-L, Pc &ox 867 514"a1 wa 9sz`)/ 9-0(e wry a 529 <br />Contractor MaJ Address City Statelbp Phone <br />WA State Contractor License Number (required) <br />Work to be clone: <br />❑ Side Sc,,%. i Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer — New Installation <br />Install Backwater Valve (outside the building) <br />❑ Cap otr Sewer <br />Ll Install Water Meter <br />bs333 S <br />City of Everett Business License Number (required) <br />FEE <br />300 <br />PERMTr# <br />U (C2�3-�r5 <br />REVISED 11110R014 <br />