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�°TILIT� E IT P LIC �'10 <br />C1T�f OE E�'ERET`T PERNiIT SERVICE� <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-881 Q- FAX 425-257-8857 — www.everettwa.org <br />�� C�,� l, C`Yv1 ���'4 i.� G��? K <br />PROJECT ADDRESS <br />Property Owner <br />Mail Address <br />Tenant Name (If this is for a commercial business) <br />� <br />fc�I/v �'%w/�.�-"i7 y .S�E/ <br />� <br />Contractor Mail Address <br />�f �� � i'�� �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 />City <br />�Install Backwater Valve (outside the buiiding) <br />❑ Cap off Sewer <br />❑ Install Water Mefer <br />REV/SED 7 i/19/20i4 <br />�`���1`� <br />r1/ <br />State2ip <br />s Y <br />State/Zip <br />C% �' <br />l �.. <br />Phone <br />� 5,��—!so <br />Phone <br />G�3 �/s s" <br />City of Everett Business License Number (required) <br />FEE <br />��p� <br />