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��� � �A .���''�' ��s�fil�I`� �PF�LI���°���9 <br />C1�°�f �F �!lEREl'i' PEi�MY'I' SE�V��E� <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX47_5=�57-8857—www.everettwa.org <br />Iqoq I`I-+�., �-. ������+ �� a�ao� <br />PROJECT ADDRESS T <br />�roperty Owner <br />tvlail Pddress <br />Tenant Name (If this is for a commercial business) <br />�fGI/U �/«/7�� <br />Coniractor <br />Address <br />/��oL G PG Qo � G i <br />VJA State Coniractor License Number (required) <br />Work to be done: <br />❑ Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer — New Installation <br />Cily <br />�Install Backwater Valve (outside the building) <br />C� Cap off Sewer <br />❑ Irstall Water Meter <br />��,��s�o,,,,�.�o,a <br />Ciry <br />SlatelZip <br />St3te2ip <br />Phone <br />Phone <br />oS3 ��s.f <br />City of Everetl Business License tJumber (required) <br />FEE <br />i1 2� Lb I <br />`� :> � <br />—1 <br />P[RM1T: <br />u I�O�—O�S <br />