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1.�3���1 � °� �iERMI�' �PPLI�ATIQ�I <br />CITV �F EVEREi�' 9'ERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, UVA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />� ? U � �1 s�- S-�- . <br />PROJECT ADDRESS <br />Property Owner <br />Mail Atltlress <br />Tenanl Name (If this is fer a commercial business) <br />�'f�G//ci %�/cun13��� S �/ <br />CoNraclor 64ai� Address <br />�f GL G PG �G.� GT <br />VJA Sfate CoMractor License Number (required) <br />Work to be done: <br />O Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer — New Installation <br />City <br />�Install Backwater Valve (outside the building) <br />❑ Cap off Sewer <br />❑ Install Water Meter <br />FFvrsvn � uavzma <br />v�� <br />City <br />v��/ <br />� �C� � <br />State/Zip <br />State/Zip <br />Phon: <br />Phone <br />oS3 ��s.f <br />City of Everett Business License �umber (required) <br />FEE <br />� �0.�0 <br />_ <br />� � � — � 5 PERMIT# <br />U 15c�5-- DD°l <br />