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lJT°ILITI( PERMIT �4PPLICATION <br />CITI( OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 – www.everettwa.org <br />��� �� ����� �v� � <br />PROJECT ADDRESS <br />�, ��{�-��i��. �� �;�.�- � � �� � <br />Property Owner Mail Address <br />Tenant Name (If this is for a commercial business) <br />City <br />— (� '� � �' <br />Phone <br />=� -=�, �' _ � � �: ��, _;' ' l - c� �I � �' ��' 4� �= '��- 6. [ ��` � � ' L '.,�, � < `! �,z.,�i -i, �- c� �i `.x ci <br />�. L ;k� � : `�- <br />Contractor Mail Address City State/Zip Phone <br />I : <br />;; �,. f >, , ��--4 � �_� ��.,G=-' �, Y� ;--- <br />S � � i <br />WA State Contractor License Number (required) <br />Work to be done: <br />❑ Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer — New Instaliation <br />Q�` Install Backwater Valve (outside the building) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />___..__...,_. <br />REVISED lJ/19/2014 <br />�-- � �: -� `� ����', <br />City of Everett Business License Number (required) <br />� 1�--��; <br />FEE <br />�, �� vo, <br />_- <br />PERMIT# <br />� i �,U°l-���' <br />