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� <br />U1'IL11'Y' f��RMIT e�PPL1��T'1�(U <br />CITY OF' EVERE�"i P�I�nIItT SEF�i/ICES <br />3200 eEDAR STREET, EVERETT, WA 98209 <br />425-257=8810 - FAX 425-257-8857 — www.everetfwa.org <br />�� � ���- � ��� <br />PROJECT ADDRESS <br />Property Owner <br />Mail Address <br />Tenant Name (!f this is for a commercial business) <br />City <br />"�✓r f�'r� �%J� <br />State/Zip Phone <br />P�l�,,�,h:� t 7 s� s��_�-� S�. Sr. ����.�°s��, �I� Gi��=�T1 <br />Contractor �%Maii Address <br />� v��� P(�� � � 3 � � <br />WA State Cantractor License Number (required) <br />l�lark to be done: <br />❑ Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer — New installation <br />City <br />� Insta{I Backwater Vafve (outside the building) <br />❑ Cap off Sewer <br />❑ {nstall Water Meter <br />:�"� f��f� <br />� � <br />REVISEO i i/19/2014 <br />'? S 7� � 3Gt� <br />5tatelZip Phone <br />OS ��� > <br />Cify of Everetf Business License Number (required) <br />FEE <br />��� �j <br />PERMIT# <br />U � ll/ � � � � �-�' �, <br />