1017 HEWITT AVE 2019-11-14 - Laserfiche WebLink

WATER / SEWER UTILITY APPLICATION A.111111 ' Niiiiwi CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 I (E) everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE.INFORMATION ' PROJECT ADDRESS: 1011 k'Mi I Alit' IF APPLICABLE: 0 OUTSIDE CITY LIMITS 0 BUILDING AREA SF 0 LOT# BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑DULEX ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL ❑INDUSTRIAL CHANGE OF USE? YE ❑YES, FROM TO UTILITY APPLICATION INFORMATION SEWER(check all that apply) WATER(checkall that apply) ❑SIDE SEWER REPAIR 0 NEW WATER SERVICE INSTALLATION ❑SIDE SEWER ALTERATION 0 COMPLETE SERVICE 0 METER ONLY ❑ NEW SIDE SEWER INSTALLATION SERVICE/METER USE: INSTALL BACKWATER VALVE(outside the building) 0 SFR ❑SIDE SEWER CAP-OFF 0 MULTI-FAMILY-#OF UNITS: ❑ SIDE SEWER RECONNECTION 0 COMMERCIAL MULTIPLE DOMESTIC WATER SERVICES REQUEST WATER SERVICE TYPE/SIZE: (circle desired size) ❑ I AM DECLINING MULTIPLE DOMESTIC WATER SERVICES FOR 0 DOMESTIC: 3/4", 1", 2", OTHER: MY MULTI-FAMILY DEVELOPMENT UNDER SINGLE OWNERSHIP. 0 IRRIGATION: 3/4", 1", 2", OTHER: ❑.I AM OPTING TO INSTALL MULTIPLE DOMESTIC WATER 0 FIRE: 1", 2", 4", 6", 8", OTHER: SERVICES FOR MY MULTI-FAMILY DEVELOPMENT UNDER 0 DOMESTIC/FIRE COMBO: 1", 2", OTHER: SINGLE OWNERSHIP. FILL OUT REVERSE SIDE OF THIS FORM. CONTACT INFORMATION OWNER NAME: apli-A71 ‘ . TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET 0\n A CITY STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: R PlAmtvikim CONTRACTOR ADDRESS: STREET I V j'r , vhr.o. CITY STATE WA • ZIP — 1ry ...,) ,e /� � � /1/}�� CONTRACTOR PHONE: ;'-®I�� CO TRACTOR EMAIL:�P` b1 t 1/41® `I.O t �� 1 ,, i CITY OF EVERETT BUSIN LIC.#(REQUIRED): CONTRACTOR LIC #(REQUIRED) .V V ..,.°1J. w...,,. ,.,.:,...a. PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: L1.12S-47) 1 2,b 19 21 Nil; P`1 )01,411.----- CONTACT EMAIL: f� (�+�b(ry ` �c �� ! , ,V AGREEMENT:The undersigned applicant agrees to comply with all provisions of the Everett Municipal node Title \• City of Evert Official Use Only 14 Water and Sewer or such other rules and regulations now existing or which may be established from time to FEE 00 time. The applicant further agrees, -. a con.! precedent to receiving service that the utilities division shall have 4770 t the right at any ' e,w' t notic ,to shut of o turn on the water supply for repairs,construction,and nonpayment.f ch-r.-s or or an other reasona i le cause.I am the owner,or I am authorized by the owner of this property to p- or he wo hich applicatio is made,and I comply with the State Contractors Law 18.27 PERMIT# RCW and 29:,200, WAC wner/Authoriz-4.gent Sig,ature Date (Revised 10/12/2015) _