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�D�a�B� ����V1�T A�����A���� . <br /> ��'�'Y' QF ��ER��T PE�M�T ���V9��� <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257=8810 - FAX 425-257-8657—www.everettwa.org <br /> � � C� �OC.�Pif�P/��7'ile- !L125� <br /> PROJECTADDRE�S ` <br /> �o�.�. `�v 2c� l���o �c, '�'.��.r2 �114��1�a ,Y�.� � � 7 -8� <br /> �'ry S�y��iP Phonc <br /> Property Owner Mad Addmss <br /> �nt�I <br /> Tenant Name(If this is for a commercial business) <br /> (`��S) <br /> � �C. ��,����� ��a. ����-�:i w , �i.��2o3 z..-rti--����� <br /> -.�-. ��, Sta1e/TP Phone <br /> Conlractor � IVailAddress <br /> ,� I����� �(0 1, 1� � — c7�i� `� �c.�v <br /> WA State Contracror License Numher(required) City of Everett Busfness�cense Number(reqwred) <br /> Vilorlc So be done: <br /> Q Side SeN�er Repair <br /> ❑ Side Sewer Alteration <br /> ❑ Side SeN�er— New Installation <br /> CvT Install Bacfcwater Valve outside the building) <br /> ❑ Cap off Sewer <br /> ❑ Install Water Meter FEE <br /> �j4 �� <br /> /, � — j — �S PERMiT# <br /> _��.�t.!/ / oate � l_J Q 5 ^ o� <br /> sig aty � <br /> atvisr�nnsrzma � � - <br />