2401 CLEVELAND AVE 2020-05-07 - Laserfiche WebLink

01WWATER I SEWER UTILITY APPLICATION 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 f www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: lg 0 I out ut I 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? X.N2 0 YES, FROM TO UTILITY APPLICATION INFORMATION SEWER(check all that apply) WATER(check all that apply) Ol(SIDE 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 I 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: `van 4' nick,( 6H i TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET 2,g 01 /112 Aft VAihd CITY fjUt STATE 1/if , ZIP 1 1 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: ierAe Piotim CONTRACTOR ADDRESS: STREETegtre1 V Ab AM ® ifirtife CITY STATE WA c ZIP ..) U4 LAI CO TRACTOR EMAIL:ailq 1 O c CONTRACTOR PHONE: 3 l 1 i CONTRACTOR LIC #(REQUIRED) t i � CITY OF EVERETT BUSIN LIC #(REQUIRED) 0 1 .,_...,: ' PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR 0 OTHER(Please Specify)y}� �y CONTACT NAME: , CONTACT PHONE: L�!/J� Zb✓Cl^9 21 f � 1► ��t1 Irk-114.---- CONTACT EMAIL: I /� ( Ic. '.' `'7® ft A I •/1 SIA/i AGREEMENT..The undersigned applicant agrees to comply with all provisions of the Everett Municipal odeVTiitt®le City of Everbtt'O'fficciaal6Use lO.nllyY v 1 - 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 have the right at any " e,w' t notice,to shut off o,turn on the water supply for repairs,construction,and 4 '30 . �✓ nonpayment. ch'r.-s or or an other reasons,le cause.I am the owner,or am authorized by the owner of this property top- or he wo ' hich applicatio -is made,and I comply with the State Contractors Law 18.27 PERMIT# RCW and 29:200 A WAC As. bl-I5e,�� i � d1 —ol3 1)(NiwneriAuthoriz gent Sig ature Date (Revised 10/12/2015)