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00111P ' WATER / SEWER UTILITY APPLICATION'
<br /> CITY OF EVERETT PERMIT SERVICES.
<br /> 3200 CEDAR STREET,, EVERETT,WA 98201
<br /> (P)425-257-8810 f, FAX 425-257-8857 (.(E)everetteps@everettwa,gov 1 www.everettwa:gov/perrnits
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<br /> FRC(.E4T ADDRESS: Li() t
<br /> IF APPLICABLE: ©�. OUTSIDE, CITY LIMITS , 0 BUILDING AREA SF LOT
<br /> BUILDING TYPE: LtrSFR OTOWNHOUSE ODUPLEX OADU OMULTI-FAIti ILY-#OF LIMITS:, OCOMMER IAL OACCESSORY•
<br /> CHANGE OF USE? 0 NO O YES, FROM TO
<br /> SEWER(check all that apply) WATER(check all that apply) '
<br /> 1DE SEWER REPAIR '0 NEW WATER SERVICE,'INSTALLATION.
<br /> 0 SIDE SEWER ALTERATION 0 COMPLETE SERVICE , 0 METER ONLY
<br /> 0 NEW SIDE SEWER INSTALLATION SERVICE/METER USE:
<br /> 0 INSTALL BACKWATER VALVE(outside the building)` 0 SFR
<br /> 0 SIDE SEWER CAP-OFF 0 MULTI-FAMILY.#OF UNITS:
<br /> i
<br /> 0 SIDE SEWER RECONNECTION .i.,..„,,,,,,,,,.„.,•..„„.,�- D COMMERCIAL ..
<br /> MULTIPLE DOMESTIC WATER SERVICES REQUEST WATER SERVICE TYPE I SIZE:(provide calcs to support size choice)
<br /> 0'I AM DECLINING MULTIPLE DOMESTIC WATER SERVICES FOR 0 DOMESTIC: 03/4" 01 02"£ OOther:
<br /> MY MULTI-FAMILY DEVELOPMENT UNDER SINGLE OWNERSHIP. D IRRIGATION: 03/4" Dr 02"'-; DOther:
<br /> 0IAMOPTING TOINSTALL MULTIPLE DOMESTICWATER • 0'FIRE: DI" 'D2" 04 Os" 08" DOther'
<br /> SERVICES FOR MY MULTI-FAMILY DEVELOPMENT UNDER 0 DOMESTIC/FIRE COMBO: 01" 02" ' OOther
<br /> SINGLE OWNERSHIP.SILL OUT REVERSE SIDE OF THIS FORM. ❑BACKFLOW PREVENTION(Outside): ORPBA ODCDA CIDC1/A
<br /> " ' CONTAC INFORMAtIOl `r.x :'. k .. ..� L
<br /> OWNER NAME:-JO II, t;" tf- 8L _.. ", {`ENANTBUSINESS NAME(It Cor)mer^c at).
<br /> OWNER MAILING ADDRESS: sTt i ,, .t10Lo� 4 �� )'pt ( r-�
<br /> CITY 'Everr_/ /: STATE r ) ZIP !8 20
<br /> OWNER PHONE: 1f. ,r i1-37 ,.1 c OWNER EMAIL:
<br /> CONTRACTOR NAME ` (),S ' ''`t �i 1rC, C"�be / r s-
<br /> CONTRACTOR ADDRESS: T sTi4tst r?OQ [ i tS /' j
<br /> GCIY` + c •1 STATE (;V z1 f •I *4 •k
<br /> CONTRACTOR PHONE: CONTRACTOR EMAIL:
<br /> CONTRACTOR LIC.#(REQUIRED) Mtekooek- at CITY OF EVERETT BUSINESS LIC:#(REQUIRE()CI o
<br /> PRIMARY CONTACT3 0 OWNER ` NTRACTOR O OTHER(Please-Specify) •
<br /> TACT N,SAME: CONTACT PHONE: i "( 7 1 '
<br /> tc.X ( LWidcr ,vCONTACT EMAIL: k. - t
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<br /> AGREEMENT:'rtie undersigned applicant agrees Io comply with all provisions of the Everett Municipal Code Title 14 Water and Sewer or such other rules and regulations now
<br /> existing orwhich they be established from time to time.The applicant further egreesr.as>a.condition precedent to receiving Service that the utilities division shall have the right at
<br /> anytime,without notice,to strut off or turn on the water supply repalra,cohsitttotlbn and nonpayment of charges or for any other reasonable cause.tam the owner,ort am
<br /> authorized by the owner of oris property to perform the work for which application is.Made,and(comply with the State Contractors Law 18,27 RCW and 2$6.2917AW4C
<br /> City.of Everett Official Use Only.:
<br /> PERMIT#
<br /> cOvvrt.,,,,
<br /> erlAutharized Age . e. Date (Revised 10/12/2018) ,
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