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r � c s r �-° e r� � ��` ►� a -r"' � €��i "� ! t""e � '�' p . < M <br />CITY OF EVERETT PERMIi SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />! �iZ`��l2�zf'nik� �' <br />PROJECT ADDRESS <br />� <br />��an� i �� ��.c�lY»u � � � �t L � �t,tic,t,{� �t- . t=ve.���e-E- �� .- �?8 'l5 l <br />Property Owner Mail Address City State/Zip Phone <br />Tenant Name (If this is for a cornmercial business) <br />��r-�ia. �r ���� /-�, i��u %-�c� � l�l�l.- O�{(.r'�i'� LV�1 ; 9�3t=��t? �.06�-'��,t�-Ot�o <br />ContraCtor Mail Address City State/Zip Phone <br />Rt�`�� ,�0.�" � �� ("��► <br />WA State Contractor License Number (required) <br />Work to be done: <br />�ide 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 i1/19/2014 <br />�7�'3�i <br />City of Everett Business License Number (required) <br />&�L�*(�� 1�5� <br />FEE <br />.� ����� <br />� <br />PERMIT# <br />UI�C��., ��oG� <br />