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������� � ���� �1����� ���1� <br />���Y �F ��%����� ��R�I� �������� <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everefitwa.org <br />t � C� �� � � L'�' i � � ti � ��C- I <br />PROJECT ADDRESS <br />� � � (:.�%�`� �Z ��- L � l ��'�' '�?���r� <br />Property Owner Mail Address City <br />� � � � C� l:� � � � � � C�1, lJl� � '1f i � <br />Tenant Name (If this is for a commercial business) <br />� <br />� '�� �� v r t� �. �.�.: � �'�=�% ` ��9'' � <br />Contractor Mail Address City <br />� t.��.-t.�- � <br />WA State Contractor License Number (required) <br />VVoi°k �o i�e done: <br />�Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer — New Installation <br />❑ Install Backwater Valve (outside the building) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />re <br />REVISED i1/i9/2014 <br />Date <br />�l �� 7 ��� �i c ��- /� �,� . <br />���i� ( -��-�.--2' U� `' "�" �l �� � � <br />State/Zip <br />State/Zip <br />Phane <br />7.��1� ��Zl����11� <br />Phone <br />City of Everett Business License Number (required) <br />FEE <br />`�.�>�v <br />� <br />PERMIT# <br />U(�0�—u57 <br />