1703 GRAND AVE 2020-03-06 - Laserfiche WebLink

,0000. WATE , / SEWER UTILITY APDL ICATIO �I�►' 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: i(ii) e_ frit" 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? 0 NO 0 YES, FROM TO UTILITY APPLICATION INFORMATION �� SEWER(check all that apply) WATER(check all that apply) EKE 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 I 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: —^ )I/YIP/W a.YU- TENANT NAME(If Commercial): OWNER MAILING ADDRESS: sTREEr CITY STATE ZIP OWNER PHONE: 9‘0(9 `` ga, 'q ) OWNER EMAIL: CONTRACTOR NAME: �(2.- -s vv-c.&_ \veliztt-•_ CONTRACTOR ADDRESS: STREET 5P4:2 Of ill 51—a v-it.WL# crrY -`6)/ STATE Lik.filfr ZIP Te 2 Q p CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED): 19-11f-Q/,,/4yb//,'/ CITY OF EVERETT BUSINESS LIC.#(REQUIRED): :u..0 �_..,...,-x_... .::,:...�. ..,. . .µ:. ::.. w,.v �M ,_r, .....,.....,,v.� _ hm.,_�._....,.,..<.�__:... �.a�__._..� PRIMARY CONTACT: ❑OWNER NTRACTOR 0 OTHER(Please Specify) COTACT NAME: CONTACT PHONE: 4 5—:"--/I/ --0/2,_3 .A,-cl- Me=1 V V - CONTACT EMAIL: ./vI'►� 'in C k-I AGREEMENT:The undersigned applicant agrees to comply with all provisions of the Everett Municipal Code Title ity 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 time.The applicant fu.her agrees,as a condition precedent to receiving service that the utilities division shall have 720 00 the right at any e,with. t notice,to shut off or turn on the water supply for repairs,construction,and nonpayme•". ch.re-s or fo any other reasonable cause.lam the owner,or I am authorized by the owner of this property • .erfo f 'e work fo which application is made,and I comply with the State Contractors Law 18.27 PE9 —e., — /f uRMIT# RCWa . 96.204'l A'. Owner ..rized Agent Signature Date (Revised 10/12/2015)