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���P �`��' P�����' ��'��Li��� @�� <br />C;i�'Y �E� ��i��2Ei�' ��t���li SE��fBCE� <br />3200 CGUAR Sl"REET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-R857 — v��nnv.everettwa.org <br />1 �nR ��r�� S-I- . <br />PROJECT ADDRESS <br />Properiy Owner <br />f✓ail Address <br />Tenant Name (If this is for a commercial business) <br />/�"fG//u %�%�c./�.�•"i�9 c-c%7 %��a✓u n/� <br />a <br />Contractor MailAddress � Ciry <br />/�"f oG G PG �o.� �T <br />VJA Stale Contraclor License Number (required) <br />Work to be done: <br />❑ Side Sevder Repair <br />❑ SideSewerAftc�ation <br />❑ Side Sevaer — Nevd Insta�lation <br />O�Install Backwater Val��e (outside the b�i!ding) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />�+rvisen i vi�ao�< <br />Cily <br />State/Zip <br />State2ip <br />Phone <br />Phone <br />GS3�/�s" <br />City of Everett 8usiness License �'um6er (required) <br />FEE <br />�_3�= <br />�FRr�rr�� <br />�J I Sp(p - 0$� <br />