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K <br /> -, k �it �� <br /> CI Y F EVERE T T PER-MillT SE RVIICES <br /> i. 3200 CEDAR STREET, EVERE i C, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857—www.everettwa.arg <br /> I-. <br /> PROJECT ADDRESS C � <br /> 1)� - �o ,„ 1, <br /> 'a( -, ���LC 203,_ State/Zip Phone <br /> Property Owner <br /> Mail Address City <br /> ;ft2i irrG <br /> Tenant Name(If this is for a commercial business) <br /> PT., �(!..)(_, 1 ;121:y1 `=.e<J Phone <br /> Contractor Mail Address <br /> City State/Zip <br /> KT: ' G V\ \''...- <br /> INA State Contractor License Number(required) City of Everett Business License Number(required) <br /> Work o be done: <br /> ❑ Side Sewer Repair <br /> ❑ Side Sewer Alteration <br /> ❑ Side Sewer— New Installation <br /> Install Backwater Valve (outside the building) <br /> ❑ Cap off Sewer <br /> ❑ Install Water Meter FEE <br /> d —_ <br /> y � S �� PERMIT# <br /> ' s-"cab— Date �J ���)C5 I ” <br /> Sigriatgfe j`/ <br /> REVISED 11/192014 <br />