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Y <br />� �' �' ■ � � � �' ■ � � � �' � I � �' � ■ � <br />CITY OF Ei/ERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257=8810 - FAX 425-257-8857 — www.everettwa.org <br />2�i, Z� ��.���� s�� <br />PROJECT ADDRESS <br />.�1,` �tii <br />Property Owner <br />�x.�'..,�.+ ��v� .; <br />Mail Address <br />,�� <br />;;��� a r <br />, <br />Tenant Name (lf this is for a commercial business) <br />City <br />����) <br />�,� 's�.-7�"� � <br />State/Zip Phone <br />`, <br />. : . , <br />� -� . — , .�.� c� ,� � 1� " f, l � ` ' � -' � f <br />- Rl . , , , <br />.� `'`-� � ,,ir: a....�= °iff . _i, � a-.� �, .F- � � L....' �: - R. i4 �.L_ `,,� � `, ? `f �{. `-' � �, 1 <br />Contractor Mail Address City State/Zip Phone <br />:^�' ` • �f',I^ ` �•'S `�C'� ��� � �1 �' l t^ <br />1 - <br />WA Stat� Contractor License Number (required) <br />VVork to be done: <br />❑ Side Sewer Repair <br />❑ Side Sewer Aiteration <br />❑ Side Sewer— New Installation <br />0��� Install Backwater Valve (outside the building) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />� <br />REVISEO il/19/2014 <br />�t - �-- �- �� <br />- "% '`�' C9:'-. <br />�-�.r��:� `� <br />�C.' <br />City of Everett Business License Number (required) <br />FEE <br />:� <br />4t._-_ � � �� �_� <br />PERMIT# <br />U �1, ��� � ���. <br />� <br />