3518 W MUKILTEO BLVD 2020-05-08 - Laserfiche WebLink

mis WATER / SEWER UTILITY APPLICATION Li II CITY OF EVERETT PERMIT SERVICES EVERETT 3200 CEDAR STREET,EVERETT,WA 98201 WASHINfTON. (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT ADDRESS: 3� p '/ M Uk11eo Y oute,va d, Ev(..v€i*. W A- R,8203 IF APPLICABLE: 0 OUTSIDE CITY LIMITS 0 BUILDING AREA SF ❑LOT# BUILDING TYPE: ASFR ❑TOWNHOUSE ❑DUPLEX ❑ADU ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL DACCESSORY CHANGE OF USE? 0 NO ❑YES, FROM TO . 0 �� q k y ro -SEWER(check ally �� ,-a,.;�� ,.�.... �; � x �-� that apply) WATER(check all that apply) KSIDE 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: 0 INSTALL BACKWATER VALVE(outside the building) 0 SFR 0 SIDE SEWER CAP-OFF 0 MULTI-FAMILY-#OF UNITS: 0 SIDE SEWER RECONNECTION 0 COMMERCIAL MULTIPLE DOMESTIC WATER SERVICES REQUEST WATER SERVICE TYPE/SIZE:(provide calcs to support size choice) 0 I AM DECLINING MULTIPLE DOMESTIC WATER SERVICES FOR 0 DOMESTIC: 03/4" 01" 02" ❑Other: MY MULTI-FAMILY DEVELOPMENT UNDER SINGLE OWNERSHIP. 0 IRRIGATION: 03/4" 01" 02" ❑Other: ❑I AM OPTING TO INSTALL MULTIPLE DOMESTIC WATER 0 FIRE: 01" 02" 04" 06" 08" ❑Other: SERVICES FOR MY MULTI-FAMILY DEVELOPMENT UNDER 0 DOMESTIC/FIRE COMBO: 01" 02" ❑Other: SINGLE OWNERSHIP.FILL OUT REVERSE SIDE OF THIS FORM. 0 BACKFLOW PREVENTION(Outside): ❑RPBA ❑DCDA ❑DCVA WiVITOr5V 0•14;4 ......� .�. Z 1 .- y 1# - ��¢�1, )h 'moi M ! OWNER NAME: Monk`Gown TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 3�L`� W(M' ( `UtLit1" o taodd emi & `-, CITY altif G4' STATE X11 Ic $/�ZIP Ws OWNER PHONE: 425-1)7 brVi (OWNER EMAIL: (OX Q Q /tOfMMI oCO WI CONTRACTOR NAME: ZOO W) O 1 V t CONTRACTOR ADDRESS: STREET QQ t I GtectAtiv000k otkike rt CITY 5jCa STATE W ZIP ° S\ CONTRACTOR PHONE: 2,06•.b-St•01$S 'CONTRACTOR EMAIL: VliVIA1Viela w w1OV )ZAOvat. • CONTRACTOR LIC.#(REQUIRED): ZOOM ZO i CITY OF EVERETT B�INESS LIC.#(REQUIRED), , PRIMARY CONTACT: ❑OWNER , CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: /.06-4111_'t4 Z /400 Frame, CONTACT EMAIL: WOo .iira 0� Vt�QO Vvoi,(� cool AGREEMENT: a undersigned applicant agrees to comply with all provisions of the Everett Municipal Code 14 Water and Sewer or such other rules and regulations now existing or which may be 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 tum 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 ner of this property • .e o he 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# - O7 1 CIO r4- - cit3 • mer/A• orized Age •nature Date (Revised 10/12/2018)