1607 HOYT AVE 2020-05-05 - 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: RD \iN\ 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? 2a-- ❑YES, FROM TO UTILITY APPLICATION INFORMATION SEWER(check all that apply) WATER(check all that apply) SIDE SEWER REPAIR 0 NEW WATER SERVICE INSTALLATION 0 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: 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 ❑ DOMESTIC: 3/4", 1", 2", OTHER: MY MULTI-FAMILY DEVELOPMENT UNDER SINGLE OWNERSHIP. ❑ IRRIGATION: 3/4", 1", 2", OTHER: 0 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: J TENANT NAME(If Commercial): ��'nAn � ��f� J'C/V y � OWNER MAILING ADDRESS: STREET CITY STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: P,m4im . CONTRACTOR ADDRESS: STREETegoset 1 ett V CITY STATE VIM�, + /ZIP SI CONTRACTOR PHONE: 0123 CO TRACTOR EMAIL:A 4\VAR 1/I 1 ,141 RIM . CONTRACTOR LIC.#REQUIRED CITY OF EVERETT BUSIN LIC.#(REQUIRED): ( ) Lith. .. 1. .. a '( .,w PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: V 6 Yk CONTACT EMAIL: /} I 14 f ( IC R10 TWA • /444 AGREEMENT..The undersigned applicant agrees to comply with all provisions of the Everett Municipal de Title City of Everblt 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,pli as ndndiiti�n,precedent to receiving service that the utilities division shall have l� !� Q the right at any1.ti(ne, / ut noticp,to° shut off ori turn on the water supply for repairs,construction,and /11 c D/ nonpayment of charges or or ani other reasons le cause.I am the owner,or I am authorized by the owner of this property to p oar)the wor f+r Which applicatio is made,and!comply with the State Contractors Law 18.27 PERMIT# RCW and 29 200 U 9)0% WAC, Owner/Authoriz •gent Signature Date (Revised 10/12/2015)