3805 HOYT AVE 2020-05-07 - Laserfiche WebLink

Aiow WATER / SEWER UTILITY APPLICATION Ni►' CITY OF EVERETT PERMIT SERVICES Nid3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 I FAX 425-257-8857 ( (E) everetteps@everettwa.gov I www.everettwa.gov/permits -.., . am. _ PROJECT SITE,.INFORMATION PROJECT ADDRESS: .abs t D/4 IF APPLICABLE: 0 OUTSIDE CITY LIMITS 0 BUILDING AREA SF 0 LOT# BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED 0 DULEX ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL 0 INDUSTRIAL CHANGE OF USE? t.2 ❑YES, FROM TO UTILITY APPLICATION INFORMATION I SEWER(check all that apply) WATER(checkall that apply) ❑SIDE SEWER REPAIR 0 NEW WATER SERVICE INSTALLATION ❑SIDE SEWER ALTERATION ❑ COMPLETE SERVICE 0 METER ONLY ❑ NEW SIDE SEWER INSTALLATION SERVICE/METER USE: §CINSTALL BACKWATER VALVE(outside the building) 0 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 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. , nn CONTACT INFORMATION lJl OWNER NAME: /1 Y t� TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET CITY STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: ' PtimilAbilm e� CONTRACTOR ADDRESS: STREET jt.01 1 14,10311tICA0 • CITY k STATE WA "'""' .. . ZIP e _.. ze CONTRACTOR PHONE:U4rACONTRACTOR EMAIL: 4\ 4.IMbl ''/I l� �®9e 1• CONTRACTOR LIC.#(REQUIRED): yti3`"`,.�t CITY OF EVERETT BUSIN' LIC #(REQUIRED)1,4 P I t Pt ® I .,....:,. PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: . CONTACT PHONE: L )612-b 9 92,1 o i 6 oil Y CONTACT EMAIL: //l / (VVf`VI�;Jyi l .c i I • AGREEMENT..The AP undersigned applicant agrees to comply with all provisions of the Everett Municipal d.de Title \ City of Evert Official Use Only g 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, a con.! precedent to receiving service that the utilities division shall haveICO the right at any ' e,w' . t notice to shut off o'•,turn on the water supply for repairs,construction,and nonpayment.f char.-s or or an other reasona i•le cause.I am the owner,or I am authorized by the owner of this property top- or he wo hich applicatio;is made,and I comply with the State Co tractor aw 18.27 PERMIT# RCW and 29:200 WACili ' \Q oa ��j wner/Authoriz-A.gent Sig1ature Date (Revised 10/12/2015)