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lJT1L,�Tl� PERIV1iT I�PF'LICATION <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 />� � � ��.� � � <br />PROJECT ADDRESS <br />a <br />Properiy Owner <br />r <br />' -�_r� ���� <br />Mail Address City <br />, <br />�'�1 ? ._.� � `1 �;- <br />Tenant Name (If this is for a commercial business) <br />� u��� <br />L.J�-r' , t✓ � � `- /'�� <br />State/Zip Phone <br />`�t t ._.���,.::1.�� iE � .�--a-� �•t %4i ._�a e�. �:� �� is= �`� •"�-'� + �� �,,',,e,: �' ;` {, � . -�\ �� � L,..-�..`i �'�.'- ' �� l, l .7 t � <br />ContraCtor Mail Address City State/Zip Phone <br />l ,,,,, • � �-- - c ; - _ ' � i1 ��..— <br />� � i E 1. '�- `,; � t �`;; J �_ , � ' � t �'�,, <br />WA State Contractor License Number (required) <br />VVork ta be done: <br />❑ Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer — New Installation <br />� <br />G-� Install Backwater Valve (outside the building) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />0 <br />Sig <br />REVISED 11/19/2014 <br />� � �-'_ <br />� , y.� . ` �� .�� f = <br />City of Everett Business License Number (required) <br />FEE <br />� �, f <br />PERMIT# <br />U � c�-o� -��e� <br />