3721 OAKES AVE EVERETT MEMORIAL STADIUM 2020-05-07

WATER / SEWER UTILITY APPLICATION /111Pd----A CITY 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 INFO MATION' !a" :': PROJECT ADDRESS: Everett Memorial Stadium -3'72-1 Ca. ..es Au G 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? ❑NO ❑YES, FROM TO UTILITY APPLICATION 1NFORMAT10k SEWER(check all that apply) WATER(check all that apply) 0 SIDE SEWER REPAIR 0 NEW WATER SERVICE INSTALLATION 0 SIDE SEWER ALTERATION 0 COMPLETE SERVICE 0 METER ONLY 0 NEW SIDE SEWER INSTALLATION SERVICE/METER USE: STALL A£14VVATER VALVE(outside the building) 0 SFR e 0 SIDE SEWER CAP-OFF -❑MULTI-FAMILY-#OF UNITS: ❑SIDE SEWER RECONNECTION L LI COMMERCIAL MULTIPLE DOMESTIC WATER SERVICES REQUEST V _ t ER SERVICE TYPE/SIZE:(circle desired size) ❑ I AM DECLINING MULTIPLE DOMESTIC WATER SERVICES FOR DOMESTIC: 3/4", 1", 2", OTHER: C MY MULTI-FAMILY DEVELOPMENT UNDER SINGLE OWNERSHIP. IRRIGATION: 3/4", 1",dip OTHER:'kJ/ 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. r CONTACT INF70(00. 40.$ ,. r * OWNER NAME: Everett School District TENANT NAME(If Comme_rc_ial): OWNER MAILING ADDRESS: STREET 3900 Broadway ary Everett STATE WA ZIP 98201 OWNER PHONE: 425-3854000 OWNER EMAIL: SKrause@everettsd.org CONTRACTOR NAME: Premier Field Development CONTRACTOR ADDRESS: STREET 207 Cedar Ave c,n Snohomish STATE WA ZIP 98290 CONTRACTOR PHONE: 360-563-5680 CONTRACTOR EMAIL: limg@premierfields.com CONTRACTOR LIC.#(REQUIRED):PREMIFD971 RW CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 42206 PRIMARY CONTACT: ❑OWNER X CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 360-563-5680 Jim Gray CONTACT EMAIL: jimg@premierfields.com 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 this property 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 PERMIT# V2/1S U tiOt — Olt 0 et./ th ized Agent Signature Date (Revised 9/23/2016)