2322 CLEVELAND AVE 2020-05-07 - Laserfiche WebLink

AWATERSEWER E UTILITY APPLICATION 744 solowl CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov l www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 9:6--12, otAiNdoitAdu IF APPLICABLE: 0 OUTSIDE CITY LIMITS 0 BUILDING AREA SF 0 LOT# BUILDING TYPE: ❑SFR-DETACHED ❑SFR ATTACHED, ❑DULEX DMULTI-FAMILY-#OF UNITS: OCOMMERCIAL ❑INDUSTRIAL CHANGE OF USE? clgNO 0 YES, FROM TO UTILITY APPLICATION INFORMATION SEWER(check all that apply) WATER(check all that apply) ASIDE SEWER REPAIR 0 NEW WATER SERVICE INSTALLATION ❑SIDE SEWER ALTERATION 0 COMPLETE SERVICE 0 METER ONLY ❑ NEW SIDE SEWER INSTALLATION SERVICE/METER USE: O INSTALL 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. CONTACT INFORMATION OWNER NAME: -.R.,4- 14rfAls TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET 2... 2,2 IV V .'LA/VJ CITY STATE WA, . ZIP 0 20 1 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: Altofi WM[01 CONTRACTOR ADDRESS: STREETeAtcrerit�t!! l I \l'h CITY STATE WA • ZIP q CONTRACTOR PHONE' DI 4 CO TRACTOR EMAIL: b!Y I •IC 'l • avt CONTRACTOR LIC.#(REQUIRED): t CITY OF EVERETT BUSINI LIC.#(REQUIRED): PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: • CONTACT PHONE: �I.4Z..., _ -'S y6(121 f 1 6✓ G� l f2 "l CONTACT EMAIL: /} l'lkik id I k Z1 v vkl I .e.„40 AGREEMENT.The undersigned applicant agrees to comply with all provisions of the Everett Municipalt/ ode Title City of EverBtt,O+ffi"ciaal4Use Only' ` 14 Wafer 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 coni''n precedent to receiving service that the utilities division shall have the right at any " e,w" • t notic to shut off o turn on the water supply for repairs,construction,and 0 V� nonpayment• ch,r•--s or or an other reasons le cause.I am the owner,or am authorized by the owner of this • property to p- or he wo .r hich applicatio ,is made,and I comply with the State Contractors Law 18.27 PERMIT# RCW and 29:200, WAC ../ ►. �,—� �, 5 - 2,01.6) u h��.� O 15 Owner/Authoriz-: •gent Sig ature Date (Revised 10/12/2015)