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. A�' d ��� B �� ������ P�����ls���l.JI`d <br />CI'�Y' ��' E�IEF:E-i T �ERMIT SERVICE� <br />3200 CEDAR STREET, EVLRETT, UVA 98201 <br />47.5-257-8810 - F/�X 425-257-8857 — www.everettw�a.org <br />373� �oc,ke.�e.l��� .4.�� `�e��ti"' wA °t8da� <br />PROJECT ADDRESS <br />Property Owner <br />�ciail Add�ess <br />Tenant Name (If this is for a commerciai business? <br />T/G//C/ /'/6�/�LS�� �5 1 Y=-/ // f✓u i✓ c. <br />;ontr�c'or tAailAddress City <br />�f GG G /�G QG.3 �= r <br />��A State Contrad'er Licer ;e �umber (required) <br />� Work to be done: <br />� <br />� O Side Sewer Repair <br />i <br />❑ Side Sewer Alter��'�on <br />❑ Side Se�ver — Ne�v Instailation <br />�Install Backvaater Valve (outside the building) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />-- s���,����z---- ----- <br />a, v�srn r vrs :,: �. <br />Cuy <br />— __ — � <br />I <br />State.2ip P�one <br />� <br />� <br />i <br />i <br />i� c� w/?' l�.fs�7.� .� .Ss 7'lso� � <br />State2�p Pho�-�e � <br />I <br />aS3vss i <br />Ci,y of �verett Business License Numher (required) � <br />� <br />1 <br />� <br />- i��-is <br />=EE <br />�j0� <br />PERh11T« <br />U ( �D � - I z� <br />