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�`�(�9�'� ����I� t�,���IC�7`I�CV <br /> CI i Y OF �VERE'��' PERMIT SERViCE� <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-Ba10 - FAX 425-257-8857 —v✓ww.everwttwa.org <br /> ��Z YVIa��2, 5'��'�.� �✓ W'A 6L0\ ' <br /> PROJECT ADDRESS <br /> �l✓1l'S� �NQ��'C/ <br /> Property0�vner ��talAadiess Ciry Staie/Z�p Phone <br /> Tenant IJame pf this is for a commercial business) <br /> �7 /�G//�i J�%u�.�:�� S �/=7 7/SnrZ �✓�. r�a�rfv �i� w/y l��s��ri 3�S7��S�7 . <br /> Contractor 1:ia8 Acdress � Ci;y State2ip Ph�ne <br /> /�P�� GPL �o3Li oS.3��s-� <br /> WA State Con:ractor License Number(required) City oi Evereri Business License �umber(required) <br /> Work to be done: <br /> O Side Sev,�er Repair <br /> ❑ Side Sewer Alteration <br /> ❑ Side Sewer — Ne�v Insiallation � <br /> �Install t3ack���afer Valve (outside the building) <br /> O Cap off Se�ver <br /> ❑ Install 1Nater Meter FEE <br /> ��o� <br /> — PERP1IT# / <br /> Signature Datc � I C � � � �� <br /> � J <br /> raev�s¢o f tn�.ama � <br /> � <br />