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� <br />������� ������ ����������� <br />�r�� �� ������� �����I� �������� <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />, <br />t "�� ;� I I�'�lr,�. � �-v-� <br />PR�JECT ADQRESS <br />Property dwner <br />Mail Address <br />Tenant Name (If this is for a commercial business) <br />City <br />:� ������. <br />StatelZip <br />Phone <br />/�f��/� �-'%�.���� s t/�7 7/ta�� �� ��,rys�f��� ��- ����� � ��-�.s�7 <br />Contractor Mail Address City State2ip Phone <br />���G G i��'L �G.� L % � <br />WA State Contractor License Number (required) <br />Work to be done: <br />❑ Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer — New Installation <br />�Install Backwater Valve (outside the buiiding) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />ature <br />REVISED 11/19/2014 <br />Date <br />GS31/s s <br />City of Everett Business License Number (required) <br />FEE <br />PERMIT# <br />� I �C�(� - �� ) <br />