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!� <br />������� ������ ����������� <br />���i � �� ��/��E�� ����1� �������� <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-881Q - FAX 425-257-8857 —www.everettwa.org <br />�I 0 `'I �r �� ��, �.' � .�U� <br />PROJECT ADDRESS ` <br />�U2��� ��J � ����v� <br />Property Owner Mail Address City StatelZip Phone <br />Tenant Name (If this is for a commercial business) <br />�"fvl/v �'%Gc.,//.%�:. <br />Contractor <br />Address <br />��GG G i��L �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 />Q�Instafl Backwater Valve (outside the building) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />� -� . <br />Date <br />REVI SED i i/19/20 i 4 <br />�l� <br />5tate/Zip <br />J �'J � J,J G <br />Phone <br />G�S3l/s s <br />City of Everett Business License Number (required) <br />FEE <br />� <br />� e� <br />PERMIT# <br />� r �j C� � ' ('��� <br />