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� <br />������� ��RIY1� 1 ������/�i A'�Ir <br />CITI( �F E\IERE�T PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257=8810 - FAX 425-257-8857 — www.everettwa.org <br />� ' -� ,� <br />� <br />PROJECT ADDRESS <br />. <br />����L��� ��� 3� � � <br />Property O ner Mail Address <br />il�, + � �t��-., <br />Tenant Name (if this is for a commercial business) <br />City <br />S�� �- �3�.3 <br />State/Zip Phone <br />'�- 6==��=� `� � � � �-�i ��:1 � t� s�.� �, C� �;' � �:� � s �°� c: ti �� �'a :;�; � �L' ? �i � � �-��i :� �i <br />� � <br />ContraCtor Mail Address City State/Zip Phone <br />. . .. � ^ � p ..�.„ ,, /,� . <br />- t i " i, = ;� 1 ��j � ; �� � �\ '4�--- C�` ^ �'7 � `� � C �:� <br />WA State Contractor License �lumber (required) City of Everett Business License Number (required) <br />1iVork to be done: <br />❑ Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer — New Installation <br />� <br />�' Install Backwater Valve (outside the building)- <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />� <br />� <br />REVISED 11/19/20i4 <br />FEE <br />� �� �� <br />� <br />PERMIT# <br />�����-�12 <br />