4715 FOWLER AVE 2020-03-06 - Laserfiche WebLink

WATER / SEWER UTILITY APPLICATION ‘444CITY 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: 14.1 15 + tki kr /, • IF APPLICABLE: 0 OUTSIDE CITY LIMITS 0 BUILDING AREA SF 0 LOT# BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑DULEX ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL 0 INDUSTRIAL CHANGE OF USE? XL() ❑YES, FROM TO UTILITY APPLICATION INFORMATION SEWER(check all that apply) WATER(check all 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: litINSTALL BACKWATER VALVE(outside the building) 0 SFR ❑ SIDE SEWER CAP-OFF 0 MULTI-FAMILY-#OF UNITS: 0 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: \levi' geof TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET CITY STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: Alt a P CONTRACTOR ADDRESS: STREET4W 1 ��•ba, CITY STATE WA, • ZIP 41 02/56 CONTRACTOR PHONE:U01.2A A5T01.2,, CO TRACTOR EMAIL:Up UUA b` �/ t IC (Apt( 1, CONTRACTOR LIC.#REQUIRED: CITY OF EVERETT BUSINI LIC.#(REQUIRED): 0 51 554t, PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: . CONTACT PHONE: L 1?„`s 1 q,�,--i 0.� a �t15 4 1 IA.. CONTACT EMAIL: /� ) I VVt / � 11. 1:1(117 ( lc. `04 / I , AGREEMENT.*The undersigned applicant agrees to comply with all provisions of the Everett Municipal I.de Title City of EverMtt Official Use Only 14 Water and Sewer or such other rules and regulations now existing or which may be established from time to FEE time. The applicant further agrees, a con.! precedent to receiving service that the utilities division shall have Lr the right at any ' e,w" t notic ,to shut off o.tum on the water supply for repairs,construction,and `QF4` ' nonpayment.f ch-r.-s or or an other reasona,le cause.I am the owner,or I am authorized by the owner of this property top- or he wo hich applicatio is made,and I comply with the State Contractors Law 18.27 PERMIT# RCW and 299 200 k WAC U I" c2 ISO(a-. 0)(4wner/Authoriz-:�•gent Sigeature Date (Revised 10/12/2015)