820 WAVERLY AVE 2020-04-03 - Laserfiche WebLink

WATER / SEWER UTILITY APPLICATION " CITY OF EVERETT PERMIT SERVICES Ore"- 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: 820 Waverly Avenue Everett WA 98201 IF APPLICABLE: 0 OUTSIDE CITY LIMITS 0 BUILDING AREA SF 0 LOT# BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑DULEX ❑MULTI-FAMILY-#OF UNITS: VICOMMERCIAL ❑INDUSTRIAL CHANGE OF USE? IBJ NO 0 YES, FROM TO UTILITY,APPLICATION,INFORMATION ;�; t SEWER(check all that apply) WATER(check all that apply) ❑SIDE SEWER REPAIR 0 NEW WATER SERVICE INSTALLATION ❑SIDE SEWER ALTERATION 0 COMPLETE SERVICE El METER ONLY p� ❑NEW SIDE SEWER INSTALLATION SERVICE/METER USE: `S- m"-- I t`1^I,C.�ICs`r� 4ovir\ ��i�I IJef� ❑INSTALL BACKWATER VALVE(outside the building) 0 SFR J ❑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) ❑IAM DECLINING MULTIPLE DOMESTIC WATER SERVICES FOR 0 DOMESTIC: 3/4", 1", 2", OTHER: MY MULTI-FAMILY DEVELOPMENT UNDER SINGLE OWNERSHIP. l 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: Everett Community College Facilities TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET 2000 Tower Street cITY Everett STATE WA ZIP 98201 OWNER PHONE: 425-388-9026 OWNER EMAIL: Patrick Sisneros (Vice President of College Services) CONTRACTOR NAME: City of Everett/Everett Utilities CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:4.25-388-9070 Molly Beeman CONTACT EMAIL: mbeeman@everettcc.edu AGREEMENT.-The undersigned applicant agrees to comply with all provisions of the Everett Municipal Code Title 14 Water and Sewer or such other rules and regulations now existing or which maybe established from time to 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 turn on the water supply for repairs,construction,and nonpayment of charges or for any other reasonable cause.I am the owner,or I am authorized by the owner of thi ro y to perform the work for which application is made,and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only Q 4:::5/7 I(� PERUMQ .// _V® Owner/Authorized Agent Signature Date (Revised 9/23/2016) •