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V������ ������ ����������IV <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR S7REET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everetfiwa.org <br />-(- l� <br />� �j�� � � �✓{���' Lt '�f <br />PROJECT ADDRESS <br />( `� � �' �' � k /Jf'�'� `7 :�` S/ U <br />Property Owner Mail Address <br />Tenant Name (If this is for a commercial business) <br />� ��l �1�'��f� <br />City <br />L�i� <br />State/Zip <br />Phone <br />� <br />�/��� j�/� �1�,��, � �� vl �:� �"��-���������v ��1�� S,� ����1���� s � ��.� �� �c� <br />ContraCtor Mail Address City State/Zip Phone <br />WA State Contractor License Number (required) <br />Worrk to f�e done: <br />Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer — New Installation <br />❑ Install �3ackwater Valve (out�ide the building) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />%% <br />�i <br />�LLv�- r - �c�� <br />Signature ` <br />REVISED 11/19/2014 <br />�y� � � � <br />City of Everett Business License Number (required) <br />FEE <br />��o � <br />PERMIT# <br />U15v 1 - ��� <br />