6304 W MAGNOLIA AVE 2016-05-25 - Laserfiche WebLink

4ETT WATER / SEWER UTILITY APPLICATION 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: 630 y (Awl im 1000 LiilY 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 ❑YES, FROM TO ,::fit, ' a, , , iii.107 6 PLICATION 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: ❑ INSTALL BACKWATER VALVE(outside the building) ❑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 ❑ FIRE: 1", 2", 4", 6", 8", OTHER: SERVICES FOR MY MULTI-FAMILY DEVELOPMENT UNDER ❑ DOMESTIC/FIRE COMBO: 1", 2", OTHER: SINGLE OWNERSHIP.RLL OUT REVERSE SIDE OF THIS FORM. CONTACT INFORMATION OWNER NAME: // /l'l AftjA .Q.J TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET `�� CITY 11Q • ,(,/\ STATE OAOA _ ZIP OWNER PHONE:I OWNER EMAIL: dir)k)f)h t ) Z -2.-0 1,MG7A51 c l�� CONTRACTOR NAME: C1 ryE I A/retV CONTRACTOR ADDRESS: STREET 1A /� •�} � l;3 1 CIT �/Y O /—��`$-ec STATE l}J A ZIP 9�1 Z 'T-> CONTRACTOR PHONE: (175--- . 7� `�SG(J(J CONTRACTOR EMAIL:�� [�( ��„►JST7A �1tii&Jc 9/'11_�I��`/ CONTRACTOR LIC.#(REQUIRED): / ` " CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 7/� w, ` PRIMARY CONTACT: 0 OWNER j'CONTRACTOR 0 OTHER(Please Specify) COj CT NA ! CONTACT PHONE: Z --?q 2._ 3C c _ `/ fW 4 -e-w_ CONTACT EMAIL: ^ �uC"Si � g_ITCnnA_7e 7_,/,4,,,,,f,i1 ; C AGREEMENT:The undersigned applicant agrees to 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 time.The applicant further agrees,as a condition precedent to receiving service that the utilities division shall have Ii ll the right at any time,without notice,to shut off or turn on the water supply for repairs,construction,and nonpa U•-• of charges or for. y o er reasonable cause.lam the owner,or I am authorized by the owner of this p•c=ity to •- •- the wo• for wh'h application is made,and I comply with the State Contractors Law 18.27 PERMIT(oOOY1 # 'CW and 98. E r LAM 3-30- 2o ‘,co____ U Own 'zed A'• rI�- Date (Revised 10/12/2015)