3815 SHORE AVE 2020-05-20 - Laserfiche WebLink

OLT WATER / SEWER UTILITY APPLICATION CITY OF EVERETT PERMIT SERVICES 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 PROJECT SITE INFORMATION PROJECT ADDRESS: 3815 Shore Ave. Everett, WA 98203 IF APPLICABLE: 0 OUTSIDE CITY LIMITS El BUILDING AREA5000 SF 0 LOT# BUILDING TYPE: I lSFR-DETACHED ❑SFR-ATTACHED ❑DULEX ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL ❑INDUSTRIAL CHANGE OF USE? 0 NO ❑YES, FROM TO UTILITY APPLICATION INFORMATION SEWER(check all that apply) WATER(check all that apply) ❑ SIDE SEWER REPAIR ❑ NEW WATER SERVICE INSTALLATION fa SIDE SEWER ALTERATION 0 COMPLETE SERVICE 0 METER ONLY ❑ NEW SIDE SEWER INSTALLATION SERVICE/METER USE: I INSTALL BACKWATER VALVE(outside the building) ❑ 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: O 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: John Kennedy TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET 3815 Shore Ave cny Everett STATE WA ZIP 98203 OWNER PHONE: 206 793-5520 OWNER EMAIL:jkennedy@newwestsite.COm CONTRACTOR NAME: New West Development, Inc. CONTRACTOR ADDRESS: STREET 2417 119th ST SW c,Ty Everett STATE WA ZIP 98204 CONTRACTOR PHONE:425 249-2382 CONTRACTOR EMAIL:jkennedy@newwestsite.Com CONTRACTOR LIC.#(REQUIRED):NEWWEWD924R9 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): ( t '( ilk Alf PRIMARY CONTACT: 1 OWNER ❑ CONTRACTOR 0 OTHER(Please Specify) A tp-1 LP'i CONTACT NAME: CONTACT PHONE:206 7935520 John Kennedy CONTACT EMAIL:jkennedy@newwestsite.com AGREEMENT:The undersigned applicant agrees to comply with all provisions of the Everett Municipal Code Title 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 turn 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 by the owner of this property to perform the 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# Owner) ut rued A ent i nature ///7 U t ® "I`001 9 9 (Revised 9/23/2016)