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s <br />UilLlil� PERMfT i4PPLICATiON <br />CITY OF EVERETT PERMIT SERVICE� <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257�8810 - FAX 425-257-8857 — www.everettwa.org <br />L� �1 � �L �� A-J �- <br />r <br />PROJECT ADDRESS <br />� ��,vL� <br />Property Owner <br />Mail Address <br />, `"��— <br />�(� � e/ <br />Tenant Name (if this is for a commercial business) <br />City <br />� `��-l�—�c��� <br />State/Zip Phone <br />.. �,�" � .. i %'� � .,�±„ [°'� �, :� �f � `. � . �. R d-},. �' � � LI.:�`'i L'" { �� � �- j <br /><'� k `� . � : �....�. C.�' (�:, �..4i '�'...� JG'i :,._�4 �-, �F. �i �-= �="� � �..' � : � ' 7�--� � <br />Contractor Maii Address City State/Zip Phone <br />, -��- -�:_ .�. � ;, � <br />. � ',.;:�� > .�..� � � .. � � �. �, � <br />WA State Contractor License Number (required) <br />Vi/ork ta be done: <br />❑ Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer — New Installation <br />f�� lnstaii Backwater Valve (outside the building) <br />❑ Cap off Sewer <br />� Install Water Meter <br />.,_.____-- <br />REVISED 11/192014 <br />; —. ,t-- ' �;;, <br />{ _., �r� .�� `� � �_' - <br />City of Everett Business License Number (required) <br />FEE � <br />PERMIT# <br />U� �a�1�C��,�� <br />� <br />