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' — ---- — � <br /> ����.�g� ��i�lilll�" �PPLICf��`I(�� <br /> �ITY �F E`e/ERE7 i i�Et�MIT SE�ViC�� <br /> 37_00 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 — wwvd.everettwa.org <br /> � <br /> � <br /> 1� ��1 d�wt�r� �lue -- <br /> PROJECT ADDRESS <br /> _��,�c-�_ � �,-� 9gac.�l _ <br /> Property Owner I��ail Address Ciry � S;ate,'Zip Phone <br /> Tenant Nz:ne Qf this is for a commercial business) <br /> i <br /> � I <br /> �"!G//ci �7 f ' <br /> /��Lt.✓l�'%J rJ .S ���%7 7� f,✓u �✓r=. �`^c:�y S 1�.//Ci' W/1' I7{5�'7� .� 537'�s�7 <br /> � I <br /> ConVacto� Idail Address City Stale2p Fhone I <br /> /�f GL G PG �G.�L% OS.3�/s s <br /> VJA State Con�ractor License Number(required) City of Everett Business License Number(required) <br /> Work to be done: <br /> ❑ Side Sewe� Repair <br /> : <br /> ❑ Side Sewer Alteration <br /> ❑ Side Sewer - New Installati�n <br /> Q�Install Bacl;water Valve (outside the building) <br /> ❑ Cap off Sewer <br /> ❑ Install bVater Meter <br /> FEE <br /> �3D.°a <br /> _ PERMIT# <br /> Signature Date �� �5 p�.� p�,� /� <br /> (J "� <br /> nevis=_o�insnaia <br />