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Jul 23 19, 02:56 Holsted's PLUMBING INC. 3605889814 p.1 "pp.—– – ... ' 44t:;—:A. . ATE I S ` E's UTILITY APPLICATION .� .. CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 I FAX 425-257-8857 1 (E) everetteps@everettwa.gav ( www.evereftwa.gov/permits . PROJECT SI E lNFOR MATibig • . 'PROJECT ADDRESS: 5 0 i Sf st, Y K`e qS o7)IIF APPLICABLE: ❑OUTSIDE CITY LIMITS 0 BUILDING AREA SF 0 LOT# ;BUILDING TYPE: ❑SFR-DETACHED SFR-•ATTACHED ❑DULEX Elm LILTI-FAMILY-#OF UNITS: ❑COMMERCIAL.. ❑INDUSTRIAL CHANGE OF USE? polQO ❑YES, FROM TO .. IUTILwpTie APPLOCATIGilk IINFORMATION . SEWER(check all that apply) WATER(check all that apply) ASIDE SEWER REPAIR ❑NEW WATER SERVICE INSTALLATION ❑ SIDE SEWER ALTERATION El COMPLETE SERVICE 0 METER ONLY 0 NEW SIDE SEWER INSTALLATION SERVICE!METER USE: 0 INSTALL BACKWATER VALVE(outside the building) El SFR ❑SIDE SEWER CAP-OFF ❑ MULTI-FAMILY-#OF UNITS: 0 SIDE SEWER RECONNECTION ❑COMMERCIAL MULTIPLE DOMESTIC WATER SERVICES REQUEST WATER SERVICE TYPE/SIZE:(circle desired size) ❑ I AM DECLINING MULTIPLE DOMESTIC WATER SERVICES FOR El DOMESTIC: 3/4", 1", 2", OTHER: MY MULTI-FAMILY DEVELOPMENT UNDER SINGLE OWNERSHIP. El IRRIGATION: 3/4", 1", 2", OTHER: i ❑ I AM OPTING TO INSTALL MULTIPLE DOMESTIC WATER ❑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. COTACINFOML�IAT `N OWNER • • • NAME: I . . . NT R mA/ :..:_ ...... .... . . . V ( i-1, BVI G X e.!fA TENANT NAME(if Commercial): OWNER MAILING ADDRESS: STREET Q 6/ ' ' �/p7� l cm, �v gi STATE to O zip V cDt OWNER PHONE:I`0? 3-7�j/ p��'" 0 5-_. �' !_ _01th OWNER EMAIL: CONTRACTOR NAME.: ti�� S7' c i. P' 1• . . ... _ .. .•_,r _ ....._.._..:..._..... ... . ..• : . M. , c 1 CONTRACTOR ADDRESS: s-rrser. 7 • t i'tx ____ -(.0'35-• r _ OTY C.V STATE 01 r Zip 9.41&320 6; CONTRACTOR PHONE:�Rij 12i;9 CS I3/ !CONTRACTOR EMAIL: CONTRACTOR LIC.AREQUIRED):f 1 c 10 SP C lM g_ CITY OF EVERETT BUSINESS LIC.#(REQUIRED)e b.aa�q 3 PRIMARY CONTACT: EI OWNER �CONTRACTOR�NWL❑OTHER(Please Specify) .__. CONTACT NAME: CONTACT PHONE: 1..-AQ QZ 3 6.o /_ /_ e-YC d' CONTACT EMAIL: i j �s _I/ IAV ,, S!J,,p�,,,,,, �/�/� , AGREEMENT:The vndersig•-.applicant agrees to comply with ell provisions of the Everett Municipal Code Title `7 VV CY/r , 1 i4 Naterand Sewer or such other rules and regulations now existing or which maybe established from time to City of v teff Official Lisa Only time.The applicant fvdher agrees,as a condition precedent to receiving service that the utilities division shall have FEE 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.f am the owner,or lam authorized by the owner of this property to perform the work for shi, plication is made,and I comply with the State Contractors Law 18,27 RCWan 6.200 WAC. PERMIT# —� ��— `7123 U ' l q 0--7 -- o3 , Owner/Authorized Agent Signature i Date (Revised 10/12/2015) 6 ct.. tech 7 0 D. Oct