6202 ROCKEFELLER AVE 2020-06-03 - Laserfiche WebLink

WATER / SEWER UTILITY APPLICATION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa,gov I www.everettwa.gov/permits PROJECTSITE'.II�F.OIh�►'�" i#, {a� �e � 3F PROJECT ADDRESS: 6202 Rockefeller Avenue Everett, WA 98203 IF APPLICABLE: ❑OUTSIDE CITY LIMITS ❑ BUILDING AREA SF ❑LOT# BUILDING TYPE: I]SFR ❑TOWNHOUSE ❑DUPLEX ❑ADU ❑MULTI-FAMILY-#OF UNITS:. ❑COMMERCIAL ❑ACCESSORY CHANGE OF USE? ❑NO ❑YES, FROM TO • � rz UTIL TY APPLICATIQN INFORMATION ~ ` :, - ,- SEWER(check all that apply) WATER(check all that apply) ❑✓ SIDE SEWER REPAIR El NEW WATER SERVICE INSTALLATION El SIDE SEWER ALTERATION ❑COMPLETE SERVICE ❑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 _ ❑COMMERCIAL MULTIPLE DOMESTIC WATER SERVICES REQUEST ' WATER SERVICE TYPE/SIZE:(provide calcs to support size choice) ❑I AM DECLINING MULTIPLE DOMESTIC WATER SERVICES FOR ❑DOMESTIC: 03/4" ❑1" 02" ❑Other: MY MULTI-FAMILY DEVELOPMENT UNDER SINGLE OWNERSHIP, ❑IRRIGATION: 03/4" 01" 02" ❑Other: ❑I AM OPTING TO INSTALL MULTIPLE DOMESTIC WATER ❑FIRE: 01" 02" 04" 06" ❑8" ❑Other: SERVICES FOR MY MULTI-FAMILY DEVELOPMENT UNDER ❑DOMESTIC/FIRE COMBO: 01" 02" ❑Other: SINGLE OWNERSHIP. FILL OUT REVERSE SIDE OF THIS FORM. ❑BACKFLOW PREVENTION(Outside): ORPBA ❑DCDA ❑DCVA CONTACT,INFORMATION ; ;k OWNER NAME: Stacey Wilson TENANT BUSINESS NAME(If Commercial):; OWNER MAILING ADDRESS sTREET6202 Rockefeller Avenue CITY Everett STATE'... WA ziP 98203 . . .. . OWNER PHONE:406-240-0966 OWNER EMAIL:Bearcreek8@msn.com CONTRACTOR NAME:Mr. Rooter Plumbing CONTRACTOR ADDRESS: sTREET2000 South 116th Street CITY SeattleSTATE WA ZIP 98168 CONTRACTOR PHONE:Mr, Rooter Plumbing CONTRACTOR EMAII:CharleneL@ mrrooterseacom CONTRACTOR LIC.#REQUIRED):MRROOP*022NE CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 038080 ,..OWNER.. . NTRACTO PRIMARY CONTACT: R ❑OTHER(Please Specify) � CONTACT NAME: CONTACT PHONE:206-651-2917 Mr. Rooter Plum b CONTACT EMAIL: CharleneL@mrrootersea.com 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 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 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,I am the owner,or I am authorized by the owner of this property to perform the work for which application is made,and I comply with the State Contractors Law 18.27 RCW and 296,200A WAC, City of Everett Official Use Only PERMIT �- -t-as U 2002 015- Owner/Authorized Agent Signature Date (Revised 10/12/2018)