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�LITI� � lVi1T APPL,��ATION <br />CITY OF E�/ERETT PERMIT SERVICES ` <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257=8810 - FAX 425-257-8857 — www.everettwa.org <br />c- � <br />��, ��, ����u,���. <br />PROJECT ADDRESS <br />�� <br />Property Owner <br />Mail Address <br />Tenant Name (If this is for a commercial business) <br />City <br />��1 �- " ��� � <br />StatelZip Phone <br />..� ; ��I?�� , �-C'i <br />� � � ,�� �} � L.�; �;�! i� ! �? � U � �-� � t ��.. �,. � � � � �..� �-i.. � � �� � � <br />ContfaCtof Mail Address City State/Zip Phone <br />�� t''`��. �� � �.���� � t� �T.-. <br />WA State Contractor License Number (required) <br />Work to be 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 />.,..._„_...,, <br />`"`__�',,� �.. <br />f'`^ <br />, si9 att� <br />REVISED 11/19/2014 <br />{` �' �"? 3 `f� L� � ' <br />City of Everett Business License Number (required) <br />FEE <br />� �Q,� �-� <br />PERMIT# <br />U I �o��- (�b��- <br />