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<br /> WATER / SEWER uriLtrt APPLICATION
<br /> CITY OF EVERETT PERMIT SERVICES
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<br /> '1111111111111." 3200 CEDAR STREET,EVERETT,INA g82,31
<br /> (P)425-257-n10 I FAX 425-257-S857 I(E)evpretleps(ITIevPiPtIwzi,quv I www everetwa.govmerm4s
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<br /> PROJECT SITE INFORMATION
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<br /> PROTECTALIBRESS: Cl A T aitcz...ti‘ L.5.
<br /> . APPLICABLE: 0 OUTSEIE CITY Li VMS a BUILDING AREA SF 0 LOT 0:
<br /> 111LOIN0 TYPE: CISTR•DETACHED "SFR ATTACKED• a DULEX CI MUL TI-FAMILY X OF UNITS___ CICOMMERCIAL MN DU GI RL
<br /> 1 ' ANGE CAUSE? 0O DYES FROM ro
<br /> i• UTILITY APPLICATION INFORMATION
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<br /> SEWER(check all Lai wrty 1 WATER i check al 11E1 arDIYI'
<br /> EiSillE SEWER REPAIR 1=1 NEW WATER SERVICE INS TALLATO'I
<br /> O SIDE SEWER ALTERATION DCCM PLE TE SERv:CE 0 METER ONLY
<br /> C1 NEW SIDE SEWER INSTALLATION SERVICE:METER uSE
<br /> O INSTALL BACKWATER VA LVE(airsde Hee Nutting) 0 SFR
<br /> 0 SIDE SEWER CAP-OFF
<br /> 1:1 SIDE SEWER RECONNECT ON 1:1 COMMERCIAL
<br /> MULTIPLE DOMESTIC WATER SERVICES REQtiesr WATER SERVICE TYPE)SIZE 0i13*thrd arse)
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<br /> 0 lAht DECLINING MULTIPLE DOLIESTIC WATER SERVICES FOR 0 DOMEST C lAI" 1" r OTHER
<br /> VI Y MULTFFAINLY DEVELOPMENT UNDER SINGLE OW NER SHIP 0 iFIRIGATION 1114- 1- r OTHER
<br /> 0 IA%I OP MO TO INSTALL MULTIPLE DOMESTIC WATER 13 FIRE r 7 a' 6", 5" OTHER
<br /> SERVICES FORM Y MuLTF FAMILY DEVELOPMENT UNDER 0 DOMESI riF IRE COMBO 1" 2" OTHER
<br /> SINGLE CO ER S H i P PJLA.Ota ROVERSE SaDE OF rpos FORM_ 0 SACK FLCAN PR EV ENTION isereadet FIRM DCEIA BCVA
<br /> CONTACT INFORMATION
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<br /> ,CAVNER NAM:ei,s 10. TENANT NAME III Cornmercial): rir,u.,, c....1
<br /> OWNER OAMIJNO ADORESS: sna.L.1 iSO t!) 0 a& OF,... T PI Ni 4'2
<br /> OWNER PHONE: tpe.,.. 7-7Z .,,AD --Ersvatiesi EMAIL:
<br /> CONTRACTOR NAME: „.,.. SA, 'II k?rt,tN sEk...).ca„,_„,,Ar.,*:,„„A,
<br /> petrimttiran AconEss: ,..., . 6
<br /> LIPIVC "-TIESti—^ ...tall‘ i,p)0 ZIP CM-044 -3
<br /> CONTRACTOR'NOSE:250 G G4,3 i i i...A. 1 "CONTRACTOR EMAIL: ALS t.4` CO,i 9-'j'A(YAP*6411. t‘j e....„(iofri
<br /> CONTRACTOR UC.aomEguRED): CITY OF EVERETT BUSINESS LIC.SkREQL,
<br /> PRAIARYCOBTACT: DOWNER CON TRACTOR in OTHER(Ptnaz,e Spec /J.,.
<br /> Cotel'ACT NAME: e0STACT PNCE: 704.::, gg t 3-71 1
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