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— --- � <br /> �J�'I�.IT'�` ��R11�lT� �PPLI�A`�'OC)�V � <br /> CITY bF EUERE"��' PERMIT SERVICE� � <br /> 3200 CEDAR STREEI', EVERGTT, VVA 98201 ' <br /> 425-257-8810 - FAX 425-257-8�57 —w�v�v.everett�ti�a.org <br /> I <br /> I <br /> �(oo$ 2u,c.tu.r ,A•,�. l%ve�P-f! �a R �� � <br /> PROJECT ADDRESS ' <br /> ���,n �.,�Ss��_l� <br /> Property Owner �Jad Acaie;> Clry StatelZ�p Phone <br /> Tenant Name (If ihis is fc,a c�mmerGal business) <br /> ��G/�U �/lkn�:���1_!�r f✓u i✓� M4 y S v�i/c�' W!�- ��5�7✓ .�`.�7��5�7 <br /> Conifactor PAailFd�ress C.ey Stat^2ip Phone <br /> /�fGLG/'G G.��T �s���ft <br /> VdA Stale Gonlraclor License Number(r=_quired) City of EeereL'�usiness L.icense Number(required) <br /> I � <br /> Work to be done: I <br /> ❑ Side Sewer Repair <br /> ❑ Side Sevder Alferation � <br /> ❑ Sidc Sewer — Nevd Installation <br /> I <br /> I �Install [3ackvaater Valve (outside the building) <br /> ❑ Cap off Sew2r <br /> ❑ Install Water Meter <br /> F[E <br /> /. ���� <br /> � _. PERh11T# <br /> Signature Date U I C 0 � _ ^� � I <br /> ,.� U � <br /> ascrs'[�i✓rsrzow <br />