2509 BAKER AVE 2020-05-22 - Laserfiche WebLink

IF—TER a SEWER UTILITY-- PPL}CAT ON t'tilllid---i ' CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 (P)425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits hh f�,/�PR©JCECCT SITE IINFOI.MATIION PROJECT ADDRESS: 2 V t1 I'JI1t 4 6( IF APPLICABLE: ❑OUTSIDE CITY LIMITS ❑ BUILDING AREA SF 0 LOT# BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑DULEX OMULTI-FAMILY-#OF UNITS: ❑COMMERCIAL ❑INDUSTRIAL CHANGE OF USE? NO 0 YES, FROM TO " UTILITY APPLICATION INFORMATION ORMATION SEWER(check all that apply) WATER(check all that apply) Cl SIDE SEWER REPAIR ❑ NEW WATER SERVICE INSTALLATION El SIDE SEWER ALTERATION 0 COMPLETE SERVICE 0 METER ONLY ❑ NEW SIDE SEWER INSTALLATION. SERVICE/METER USE: INSTALL BACKWATER VALVE(outside the building) 0 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: — ❑ 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. 1 NTC I`T INFORMATION OWNER NAME: TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET CITY STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: PrP' P1RIA4k IA a CONTRACTOR ADDRESS: STREET (f ll 1 VIllA d ML_' Are). CITY P.A1Ore, I STATE WA • ZIP alt n411 CONTRACTOR PHONE:U 2.,.)Z4 O0 b CONTRACTOR EMAIL: 161IAA"v p/\ ,6.�, 1� I olwai 14 IV/i CONTRACTOR LIC.#(REQUIRED): kkiI 1 � l �, N CITY OF EVERETT BUSINtS LIC #(REQUIRED): © 1 5 PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: C/ 9 2 2 4921 a � �� CONTACT EMAIL: /a �i1 . IN vi c re /0amafi& o COO 9 AGREEMENT-The undersigned applicant agrees to comply with all provisions of the Everett Municipal 1 de Title �Y � City of Ever I Official Use Only 14 Water and Sewer or such other rules and regulations now existing or which maybe established from time to — FEE time.The applicant further agrees, a conch , precedent to receiving service that the utilities division shall have the right at any ' e,W. . t notic,to shut off o turn on the water supply for repairs,construction,and 30 CC nonpayment. ch.r.-s or or an other reasona+Je cause.lam the owner,or am authorized by the owner of this - property to p: or e wohich applicatio is made,and I comply with the State Contractors Law 18.27 PERMIT# 7and29200' WACtnUn f io / 052nerlAuthoriz-I;gent Sig'attire Date (Revised 1`0//12/2015) !/J,