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��A�.��r� ���n�i�- ,���Li���A�� <br /> CIT�f �F EVEREl'�' PERMIT SERVICE� <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 —www.everettwa.org <br /> I��6 I,✓e�,�-,��e — <br /> PROJECT ADDRESS <br /> //' C �—L�� <br /> Property Owner t�4ail Atldress Ciry SIa1elZip Phone <br /> Tenant Name (If this is ror a commercia business) <br /> �'i��-.//c'i � f� ' <br /> �lt.� �+=Y S�/%7 7I fru i✓c. Mc:i y S v��/ 'v w/?' l�{5�7�i .� .SJ 7'�5�7 <br /> CoMractor h4ail Address � Cily StatelLip Phone <br /> /�/�oGl.r'G 9o3�i oS3�ls.f <br /> WA State Contraclor License Number(required) City of Everett Business License �umber(required) <br /> Work to be done: <br /> ❑ Side Sewer Repair <br /> ❑ Side Sewer Alteration <br /> ❑ Side Sewer — New Installation <br /> tD�lnstall Backwater Valve (outside the building) <br /> ❑ Cap ofi Sewer <br /> ❑ Install Water Meler <br /> FEE <br /> dd <br /> 30 <br /> C � _ L�///�//� PERMIT� <br /> Signature Date � � ��l j � _0/"�" � <br /> V`-� �J <br /> FFVISEO f I/f9?01< <br />