1416 E MARINE VIEW DR 2020-05-08

#00111111i. . WATER / SEWER UTILITY APPLICATION CITY OF EVERETT PERMIT SERVICES t 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 NFA :: 1 _ PROJECT SITE I ItMAT10N x, ..,t �... , PROJECT ADDRESS: 1 (.2 944 PAK i I W V\f1tit 01' • 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? 0 YES, FROM TO UTILITY APPLICATION INFORMATION , SEWER(check all that apply) WATER(check all that apply) .SIDE SEWER REPAIR 0 NEW WATER SERVICE INSTALLATION ❑ SIDE SEWER ALTERATION 0 COMPLETE SERVICE 0 METER ONLY ❑ NEW SIDE SEWER INSTALLATION SERVICE/METER USE: 0 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 ❑ 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 ❑ DOMESTIC/FIRE COMBO: 1", 2", OTHER: SINGLE OWNERSHIP. FILL OUT REVERSE SIDE OF THIS FORM. CONTACT INFORMATION OWNER NAME: IY r r7r0i hf 1S vu..) NAME A(If Commercial): OWNER MAILING ADDRESS: STREET }4 W way 1 V'.V \j I tAA a - . /� Q� CITY "' ellitiltrtSTATE WZIP 41 Z I OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: f l I j Q,vuott (p ` 1 CONTRACTOR ADDRESS: STREET 1 Y Th V A1141 Art/. CITY STATE MI e ZIP/ a0 CONTRACTOR PHONE:l.n ) Cbl-Q12� CO TRACTOR EMAIL: r�1 ' 1`yut I IC 0!/I l; UIRED: LIA 4 PI) CITY OF EVERETT BUSIN LIC #(REQUIRED): O l CONTRACTOR LIC #{REQ ) „.N, ,, AA 511(0 PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: , 9 CONTACT PHONE: 1,1-12,t3') 2,2—q g 2.1 Y 6 1 t 1 A CONTACT EMAIL: A / ii 1 Kiva,t�O [ lc C,'�-7®a y rtvl/�,l .I�F-�"' ` AGREEMENT:The undersigned applicant agrees to comply with all provisions of the Everett Municipal l•de Title V City of Evert Official Use Only 14 Water and Sewer or such other rules and regulations now existing or which may be established from time to FEE 0time.The applicant further agrees, a con., precedent to receiving service that the utilities division shall haveA7, / the right at any e,w' • t notic to shut off o,turn on the water supply for repairs,construction,and nonpayment r ch-r.-s or or an other reasons le cause.I am the owner,or I am authorized by the owner of this property top- or he wohich applicatio is made,and I comply with the State Contractors Law 18.27 PERMIT# RCW and 29 200, WAC WAC tp .? I u gt1-0 5 • caner/Authoriz- gent Sig'ature Date (Revised 10/12/2015)