2920 16TH ST 2020-02-24 - Laserfiche WebLink

,0)41/.......j._j._ , WATER I SE i' ER UTILITY iT I'LICATION CITY OF EVERETT PERMIT SERVICES ,_ 3200 CEDAR STREET, EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 I (E) everefteps@everettwa.gov I www.everettwagov/permits PROJECT SITE INFORMA`i ION .:,,,-m7,..,..,-_, 4 LL PROJECT ADDRESS: 2/1(),0 160 S . IF APPLICABLE: 0 OUTSIDE CITY LIMITS 0 BUILDING AREA SF 0 LOT# BUILDING TYPE: ❑s R-DETACHED OSFR-ATTACHED ❑DULEX ❑MULTI-FAMILY#OF UNITS: ❑COMMERCIAL ❑INDUSTRIAL CHANGE OF USE? NO ❑YES, FROM TO UTILITY APPLICATION INFORIIIATION ',-4-:.... SEWER(check all that apply) WATER(check all that apply) SIDE SEWER REPAIR 0 NEW WATER SERVICE INSTALLATION ❑ S E SEWER ALTERATION 0 COMPLETE SERVICE 0 METER ONLY E 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: ' 01AM 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: S1-I�101-,NA P 60 Ilk "i(r) TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET `L61 '��" �� CITY )E`u--)E'-cr- STATE w1 ZIP i g 2© i OWNER PHONE: 246 (g.-11 2.-dIS7 OWNER EMAIL: 51'?CI4)J.A©O-7 A6 l, CO1LA CONTRACTOR NAME: j t)IA--J tY��+a ce W-e'.- `- ' j M J,-1 Cr CONTRACTOR ADDRESS: STREET (2v2 2 14 s' ' T(-- ,��5(J Q r CITY tM 0 N'C-Liar W > Q 'f t t. STATE (� itt ZIP "o -f CONTRACTOR PHONE: 2 (' t'L(1 CONTRACTOR EMAIL: �' -A 3.3,lu 0" .}S D��f L x(L e-0 CONTRACTOR LIC.#(REQUIRED) Z _ rA0A fl S OF EVERETT BUSINESS LIC.#(REQUIRED): � Z PRIMARY CONTACT: 0 OWNER IU CONTRACTOR 0 OTHER(Please Specify) - /` CONTACT NAME: CONTACT PHONE: 7 06 OJ37 2 )6Stit L -.M.L.-0 CONTACT EMAIL: .3AO ,II‘Ats)A-13 V C.Li. --11.__z 66sr-1 AGREEMENT:The undersigned applicant agrees tc'comply with all provisions of the Everett Municipal Code Title City of Everett Official Use Only 14 Water and Sewer or such other rules and regulations now existing or which may be established from time to FEE �O time.The applicant further agrees,as a condition precedent to receiving service that the utilities division shall have the right at any time,without notice,to shut off or tum on the water supply for repairs,construction,and L �. nonpayment of charges or for any other reasonable cause.I am the owner,or I am authorized by the owner of this property to perform the work for which application is made,and I comply with the State Contractors Law 18.27 PERMIT# RCW and 296,200A WAC. / U & DI -02-6 Owner/Authorized Age t Signature pate (Revised 10/12/2015)