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1111111111 WATER I SEWER UTILITY APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> EVERETT 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 (E)everetteps@everettwalov www.everettwagoviperrr(Its <br /> WASHINGTON <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 1402 Silver Lake Road <br /> IF APPLICABLE: 0 OUTSIDE CITY LIMITS Li BUILDING AREA SF al LOT# <br /> BUILDING TYPE: R:SFR :.-.T.ITOWNHOUSE ['DUPLEX EADU L-MULT1-FAMILY#OF UNITS: EICOMMERCIAL ACCESSORY <br /> CHANGE OF USE? El NO RI YES, FROM SEPTIC TO CITY SEWER <br /> UTILITY APPLICATION INFORMATION <br /> SEWER (cheek all that apply) WATER (check all that apply) <br /> O SIDE SEWER REPAIR 0 NEW WATER SERVICE INSTALLATION <br /> 0 SIDE SEWER ALTERAT'ON El COMPLETE SERVICE Li METER ONLY <br /> II NEW SIDE SEWER INSTALLATION SERVICE/METER USE: <br /> D INSTALL BACKWATER VALVE(outside the building) 0 SFR <br /> 0 SIDE SEWER CAP-OFF 0 MULTI-FAMILY-#OF UNITS: <br /> El SIDE SEWER RECONNECTION E COMMERCIAL <br /> MULTIPLE DOMESTIC WATER SERVICES REQUEST WATER SERVICE TYPE/SIZE:(provide calcs to support size choice) <br /> El I AM DECLINING MULTIPLE DOMESTIC WATER SERVICES FOR Li DOMESTIC: 03/4" Or 1:12" 00ther: <br /> MY MULTI-FAMILY DEVELOPMENT UNDER SINGLE OWNERSHIP. Li IRRIGATION: 03/4" 01" 02" CEOther: <br /> 1-I AM OPTING TO INSTALL MULTIPLE DOMESTIC WATER El FIRE: Dr E2. 04" 06" 1:38" Daffier: <br /> SERVICES FOR MY MULTI-FAMILY DEVELOPMENT UNDER Li DOMESTIC/FIRE COMBO: Ell" 02" DOther <br /> SINGLE OWNERSHIP. FILL OUT REVERSE SIDE OF THIS FORK El BACKFLOW PREVENTION(Outside), I7P,PE3A 7DCDA ODCVA <br /> CONTACT INFORMATION <br /> OWNER NAME: ANNA BORN TENANT BUSINESS NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 1402 SILVER LAKE ROAD <br /> EVERETT STATE WA 98208 <br /> OWNER PHONE:206-963-1584 OWNER EMAIL: AEBORN@OUTLOOK.COM <br /> CONTRACTOR NAmE:APOLLO PLUMBING <br /> CONTRACTOR ADDRESS: STREET 5407 71ST AVE NE <br /> ciTy MARYSVILLE STATE WA zlp 98270 <br /> CONTRACTOR PHONE:425-387-1507 CONTRACTOR EMAIL:D EBBIE©APOLLOPLUMBING.COM <br /> CONTRACTOR LIC.#(REQUIRED):APOLLOP 1.903LT CITY OF EVERETT BUSINESS LIC.#(REOLIIRED): 053455 <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR L OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:425-387-1507 <br /> DEBBIE RUSSELL CONTACT EMAIL:DEBBIE©APOLLOPLUMBING.COM <br /> 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 <br /> 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 <br /> any time without natio notiry1,shu .ff or turn on the water supply for repairsconstruction,and nonpayment of charges or for any other reasonable cause. am the owner,or I am <br /> # rued by the ov er of rS p,perry to perform tie work for which application is made,and I comply with the Stare Contractors LaW18.27 RCW ond 290 200A WAC <br /> City of Everett Official Use Only <br /> PERMIT <br /> A A <br /> • nor/Au horized Agent S g ature Date (Revised 10/12/2018) <br />