4905 COLBY AVE 2020-05-22 - Laserfiche WebLink

`,iATE / SE"i,'EL! UTILITY APPLICATION 4. 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 r� � PROJECT SITE INFORMATION PROJECT ADDRESS: 4 - l 0 t7 06\ n IF APPLICABLE: CI OUTSIDE CITY LIMITS f ❑ BUILDING AREA SF ❑ LOT# BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑DULEX ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL DINDUSTRIAL CHANGE OF USE? Yr____ D YES, FROM TO UTILITY APPLICATION INFORMATION SEWER(check all that apply) WATER(check all that apply) ❑ SIDE SEWER REPAIR 0 NEW WATER SERVICE INSTALLATION ❑ SIDE SEWER ALTERATION ❑ COMPLETE SERVICE 0 METER ONLY ❑ NEW SIDE SEWER INSTALLATION SERVICE/METER USE: INSTALL BACKWATER VALVE(outside the building) ❑ SFR ❑ SIDE SEWER CAP-OFF ❑ 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 ❑ DOMESTIC: 3/4", 1", 2", OTHER: MY MULTI-FAMILY DEVELOPMENT UNDER SINGLE OWNERSHIP. El IRRIGATION: 3/4", 1", 2", OTHER: ❑ I AM OPTING TO INSTALL MULTIPLE DOMESTIC WATER ❑ FIRE: 1", 2", 4", 6", 8", OTHER: SERVICES FOR MY MULTI-FAMILY DEVELOPMENT UNDER El DOMESTIC/FIRE COMBO: 1", 2", OTHER: SINGLE OWNERSHIP. FILL OUT REVERSE SIDE OF THIS FORM. CONTACT INFORMATION OWNER NAME: TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET CITY STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: 1 , ��YVI At o CONTRACTOR ADDRESS: STREETt y +1b V(/LWLa/ /� CITY e STATE WA • ZIP - 1,'0 166 CONTRACTOR PHONE: J'[ AA t O12' I CONTRACTOR EMAIL:a�` v I k w / NW l l O / CONTRACTOR LIC.#(REQUIRED): I,' * ` I, V CITY OF EVERETT BUSIN LIC.#(REQUIRED): ®511551 PRIMARY CONTACT: ❑OWNER ❑ CONTRACTOR ❑ OTHER(Please Specify) CONTACT NAME: t, Y� CONTACT PHONE: 1 1 2.2T q g 21 • �9 Ys ✓�I CONTACT EMAIL: /� )( ��jt�A ` C Z41I./,'' ®4I . AGREEMENT:The undersigned applicant agrees to comply with all provisions of the Everett Municipal Oode Title I \- City of Everbtt Official Use Only 14 Water and Sewer or such other rules and regulations now existing or which may be established from time to FEE time. The applicant further agrees, S`a co73ifl�n precedent to receiving service that the utilities division shall have O/ the right at any " e,w" t notic ,to shut off o turn on the water supply for repairs,construction,and nonpayment f ch r s or or an other reasons le cause.I am the owner,or I am authorized by the owner of this property top or he wo hich applicatio is made,and I comply with the State Contractors Law 18.27 u MIT O RCW and 29 çA \ Jf wner/Authogent Sig ature Date (Revised 10/12/2015)