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• <br /> N <br /> ` LU 1J PERMITJ uPP UCA L L n� <br /> Ci Y SF EVERE c J P ERMT SEMMES <br /> 3200 CEDAR STREET, EVERE i t, WA 98201 <br /> 425-257=8810 - FAX 425-257-8857—www.everet ia.org <br /> 2Dc:L <br /> PROJECT ADDRESS ' <br /> 21)1 ejJ (e A qty! l V51 S <br /> Property Owner <br /> Mail Address City <br /> State/Zip Phone <br /> Tenant Name(if this is fora commercial business) <br /> ctbn� (Li 2-5) �^ ��q,o`er .. o - %- '%•('G? J�{, Li i% l:i l;3 �''t State/Zip Phone <br /> Contractor Mail Address City <br /> A sr'(,i,.c<! City of Everett Business License Number(required) <br /> SNA State Contractor License Number(required) <br /> Work to be done: <br /> ❑ Side Sewer Repair <br /> O Side Sewer Alteration <br /> Q Side Sewer—New Installation <br /> EA/Install Backwater Valve(outside the building) <br /> © -Cap off Sewer <br /> ❑ Install Water Meier FEE <br /> _5 PERMIT# <br /> Sig atyiDate U <br /> 6 3 D <br /> t e J/ /� '✓ v <br /> REVISED i1/132a14 <br />