1601 RAINIER AVE 2022-05-11 - Laserfiche WebLink

WATER / SESL 'ER 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: l�D' fl\V y IF APPLICABLE: ❑ OUTSIDE CITY LIMITS ❑ BUILDING AREA SF ❑ LOT# BUILDING TYPE: ❑SFR-DETACHED EISFR-ATTACHED ❑DULEX ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL ❑INDUSTRIAL CHANGE OF USE? I•'di NO ❑YES, FROM TO UTILITY APPLICATION INFORMATION SEWER(check all that apply) WATER(check all that apply) ❑SIDE SEWER REPAIR ❑ NEW WATER SERVICE INSTALLATION ❑ SIDE SEWER ALTERATION 0 COMPLETE SERVICE ❑ METER ONLY ❑ NEW SIDE SEWER INSTALLATION SERVICE/METER USE: INSTALL BACKWATER VALVE(outside the building) 0 SFR ❑ SIDE SEWER CAP-OFF ❑ MULTI-FAMILY-#OF UNITS: ❑ SIDE SEWER RECONNECTION ❑ 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. ❑ IRRIGATION: 3/4", 1", 2", OTHER: ❑ I AM OPTING TO INSTALL MULTIPLE DOMESTIC WATER El FIRE: 1", 2", 4", 6", 8", OTHER: SERVICES FOR MY MULTI-FAMILY DEVELOPMENT UNDER ❑ DOMESTIC/FIRE COMBO: 1", 2", OTHER: SINGLE OWNERSHIP. FILL OUT REVERSE SIDE OF THIS FORM. CONTACT INFORMATION OWNER NAME: -FA ft Y l (AW Y (1,-/1 TENANT NAME(If Commercial): IA V OWNER MAILING ADDRESS: STREET v` (tP Cr glit) r i n S CITY STATEkia, ZIP q,Oa/�V OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: A-ri- PtimilAkfr?\ CONTRACTOR ADDRESS: STREET i Upi 1 \ , CITY STATE WA o ZIP 401,02/56 ®1 I l �� 1 1 O a CONTRACTOR PHONE: CO TRACTOR EMAIL: I' ,/!. � � i CONTRACTOR LIC.#(REQUIRED): '� �; 14 1, 1,, 1 CITY OF EVERETT BUSIN LIC.#(REQUIRED): ®51 5 PRIMARY CONTACT: ❑OWNER ❑ CONTRACTOR ❑ OTHER(Please Specify) CONTACT NAME:g® . CONTACT PHONE: L �61 ZJ G�(/2,1 A 6 d r ecu1\ Yr/LH,, CONTACT EMAIL: % 1. ii I with Lce ► l" iAI •W AGREEMENT:The undersigned applicant agrees to comply with all provisions of the Everett Municipal1/ lode Title City of EvertY Official Use Only 14 Water and Sewer or such other rules and regulations now existing or which may be established from time to FEE f'r`y time. The applicant further agrees,�a condiitiSn precedent to receiving service that the utilities division shall haveUC/ 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 reasona,le cause.I am the owner,or I am authorized by the owner of this 4' () property top or he wo .r hich applicatio lis made,and I comply with the State Contractors Law 18.27 PERMIT# RCW and 29 200•• WAC b.- -01 e ��O�I Owner/Authoriz- gent Sig"ature Date (Revised 10/12/2015)