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��AL..9`�?� ��F��rf01�' �,PP�IC�4�'I�N <br /> C1�'Y fl�' EVERETT PEf�NiIT SERVICES <br /> � 37_00 CEDAR STREET, EVERETI', WA 98201 <br /> 47_5-257-8810 - FAX 425-257-8857 —�w�va.everethva.org <br /> I�I,�r� 2,�� � ,- A�� <br /> PROJECT ADDRESS <br /> ��✓.Cr{'�P � A){�-��cZU� <br /> PrOperty Owner Irta�l AdJress Ciry �� St3te/Zio Phonc <br /> Tenant Name(If this is ter a commerciai business) � <br /> I �L � <br /> /7 /G//U � � <br /> � �%t�✓�l3 �y S�/.:7 7� ���. Nc'. r+c:�vSv,ii� w/�- I?4�7� �.�s7—/S�7 <br /> COn,racto� 1,1ailAdtlress Ciry State2�D Phone ' <br /> /��oG G PL�o3�1 aS3�/s s � <br /> � <br /> WA State Contractor License Number(required) City oi Everett 9usiness License Number(required) � <br /> Work to be done: I <br /> � <br /> ❑ Side Sewer Repair i <br /> I � <br /> � Side Sewer Alteration -� � <br /> i <br /> ❑ Side Sewer — New Installation <br /> I <br /> l�install Backvaater Valve (outside the building) <br /> ❑ Cap off Sewer <br /> ❑ Install Water Meter <br /> f[E <br /> �O°C� <br /> -- �- 2�=�__ PERh1IT# <br /> Signature Date lJ I � O S— O� 1 <br /> rzcv�sen+vrsrfoie <br />