2224 OAKES AVE 2016-05-25 - Laserfiche WebLink

4eFrr WATER / SEWER UTILITY APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 I FAX 425-257-8857 1 (E)everetteps@everettwa.gov I www.everettwa.govipermits PROJECT SITE INFORMATION • PROJECT ADDRESS:22 z4 OQ 4 cs Ave_ - IF APPLICABLE: CI OUTSIDE CITY LIMITS ❑ BUILDING AREA SF 0 LOT BUILDING TYPE: 1SFR-DETACHED ❑SFR-ATTACHED ❑DULEX ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL ❑INDUSTRIAL CHANGE OF USE? 21"NO ❑ YES. FROM TO UTILITY APPLICATION INFORMATION SEWER(check all that apply) WATER(check all tha:apply) EKIDE SEWER REPAIR ❑NEW WATER SERVICE INSTALLATION ❑SIDE SEWER ALTERATION 0 COMPLETE SERVICE I:3 METER ONLY ❑NEW SIDE SEWER INSTALLATION SERVICE/METER USE ❑ INSTALL BACKWATER VALVE(outside the building) 0 SFR 0 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) 0 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. 0 I AM OPTING TO INSTALL MULTIPLE DOMESTIC WATER 0 FIRE. 2" 4". 6" 8". OTHER: SERVICES FOR MY MULTI-FAMILY DEVELOPMENT UNDER 0 DOMESTIC/FIRE COMBO I" 2". OTHER: SINGLE OWNERSHIP.FILL OUT REVERSE SIDE OF THIS FORM. CONTACT INFORMATION OWNER NAME: i -r-cki µo HID fn TENANT NAME(If Commercial): OWNER MAILING ADDRESS: sri_CT2,2�2E4 D 'o,keS u014- rcm' Eve e* ezirotcZ0I OWNER PHONE: 2,dS-3510`025 2- OWNER EMAIL: L CONTRACTOR NAME: m r. ' )L��l a b((�C� E k'e+t ) CONTRACTOR ADDRESS: srrtee! 2 (S t I I _TL�1�� J / ,try\'e l l4 37.4-F nF qi'g J G28- CONTRACTOR PHONE: 2,p(,p-(951 - 29( (7 CONTRACTOR EMAIL: CY-ark-neL CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#;REQUIRED;: PRIMARY CONTACT: la OWNER LRCONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:(0-730 _053 Li m n n 1 f U 4,7 CONTACT EMAIL:cher LexuL.Emrrov - c.Ct-iyi AGREEMENT rhe uncorslgned apoiicant es to comply w,th a,+p,pvisJns of the E.eren M,,n,cipa'Code LUe City of E.erett Official Use Only "4 Neter and Sewer or such other!vies and iegu,ations now exishny,a!Much ma,be e;raolrshe,l clan,time lu !'rne. The appncent further agrees as a condilloh preceuert to rece,virse'ti,ce that rhe tm:,hes U,v.,on;rai'rave FEE :ho right et anytime.without noUCo.to s"ut Df c'!'turn on the waver supply I:A-'eF8VS.:U'Str'lC'W,.dnU4r5OF ,tonpayrnent of S.4arges or(Or any o(,ter,easonan'a'i,lye.1 e'n:he'Iwnu. or!a,n ,whorreu by:he owner ci t',,i proper(} to oerfarrn the won, for whk'applicat,on,s made.and!camel,with the State Co,t ac:ors Law le 2' PERMIT ie 29 WAC Q.� c Co U IUD l' ORD Owner Authorized Ag r ,na ire 6 Date ;Ror,secl tl),2i.'073i