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������ i ��IV1�� � ������� IY <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />�,��5� C�-.�r`%�9�f`,��d Eti:4�/ <br />PROJECT ADDRESS <br />..-- ✓�-E.��-�-� �� r� � " � • � � <br />Prope Owner Mail Address City <br />Tenant Name (If this is for a commercial business) <br />, ,, <br />5`���' � ��zboe�►sr� �� � <br />Contractor Mail Address City <br />�� � ���/v`� <br />WA State Contractor License Number (required) <br />Wo�k to be done: <br />❑ Side Sewer Repair <br />C�' Side Sewer Alteration <br />❑ Side Sewer — New Installation <br />❑ Install Backwater Vaive (outside the building) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />, <br />, <br />/ <br />� <br />�. � �� <br />nature <br />REVISED 11/i9/2014 <br />Date <br />State/Zip <br />State/Zip <br />�ts �i 3 <��"% <br />Phone <br />�`r`' Yw� � --'�s� <br />� �,�� `�' � 2/� <br />Phone <br />� � l �? Y (� � <br />City of Everett Bu iness License Number (required) <br />FEE <br />�� �� <br />PERMIT# <br />U��6��1��� <br />