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r r -r- r r y ~s� � �- ��� �. W. ,.�'� t -'i°" �@ �j ��e e � � ,.,p,�. y ;a:�a r <br />CITY OF EVERET'i PERMIi SERVICE� <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />�3 i l � 2�.�� � �..�- �-- �,,�-�-�- �� � �, ; <br />PROJECT ADDRESS <br />Property Owner <br />Mail Address <br />Tenant Name`(If`this is for a commercial business) <br />City <br />State/Zip <br />Phone <br />��°'�! ��J��i-�1'" I � � t'V l�tti � %�� t 1 �-ri'�c'.l��o��� / � lJV 7 "J��i' � /`� V� �-- � ��Ut Cvi- <br />Contractor Mail Address City State/Zip Phone <br />�a �� �� � � 22���L <br />WA State Contractor License Number (required) <br />Work to be done: <br />Side Sewer Repair <br />� <br />❑ Side Sewer Alteration <br />❑ Side Sewer — New Installation <br />❑ Install Backw�ter Valve (outside the building) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />re <br />REVISED 11/19/20i4 <br />2 <br />%S <br />o� � �7 �u� <br />City of Everett Business License Number (required) <br />FEE <br />� v �� <br />PERMIT# <br />U�S�C��-�Iz <br />