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�1���� �G���� �1i��������� <br />CIiY OF EVERETi PERMI`T SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - ww�N.evereftwa.org <br />� �/ � �Z %a�,��� ,�U�; <br />PROJECT ADDRESS <br />—,��1a�7 � � � /��s��� v��-� �� �� ��✓c�`Pi'� �,=� ��Z� � <br />Property Owner Mail Address City State/Zip Phone <br />Tenant Name (If this is for a commercial business) <br />Contractor Mail Address <br />`�/"� -/,' � <br />� l (i � �1J � �! /�T Q �! c� � <br />WA State Contractor License Num er (required) <br />Wof•� to i�e don�: <br />� Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer — New Installation <br />�r io( �G�` _����'� � D�t'�%��zy�) %� <br />City State/Zip Phone <br />❑ Install Backwater Valve (outside the building) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />�� �� <br />Signature <br />REVISED 11/19/2014 <br />City of Everett Business License Number (required) <br />FEE <br />.3��)� L} <br />�'� <br />-%i, -� S PERMIT# <br />Date ' � <br />U �� C z c; � <br />� <br />