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��VLV�'� �'��i�fiY`�� A�iPiLV�A`�V�i�V <br /> CITY OF EVERETT PERMIT SERVICES <br /> 37.00 C[DAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 —www.everettv+a.org <br /> J� 2 // 7 I.�c��r�re A.rL <br /> PROJECT ADDRESS <br /> n if� /toc��e� — <br /> PropertyOwner t.7ailAddress City SWte/Z�p Phono <br /> Tenant Name Qf this is for a commercial business) <br /> g/�a/�' l���t/��n G 55�7 7fmiA'c ,✓G rw�sv,rr� wA'f�}'1�7v s`�7 /S"o7 <br /> Conlractor MadAddress City State/Zip Phone <br /> A�a��i���G��y ��S�vss` <br /> VJA State Contractor License Number(required) City of Everett Business License Number(required) <br /> I I <br /> Work to be done: <br /> ❑ Side Sewer Repair ' <br /> ❑ Side Sewer Alteration I <br /> ❑ Side Sewer— Netiv Installaiion <br /> �nstail Backwater Valve (ouiside the building) <br /> ❑ Cap off Sewer <br /> ❑ Install Water Meter <br /> PEE <br /> �O �D <br /> C_ �Z�/��� PERh1IT# <br /> Signature �-- Daic � ��D �M I�� <br /> FEL'ISED I1H9GOtC <br />