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Feb 04 20, 06:00 Holstad's PLUMBING INC. 3605889814 p.1 <br /> WAVE!'; I SEWS ' UTILITY APP UCATII•N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT-, WA 98201 <br /> (P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@evereftwa.gov 1 www.everettwa.gov/permits <br /> . PRO'JECT SITE II*FORRIVIAT%ON <br /> PROJECT ADDRESS: t : <br /> . q. - <br /> 0 . <br /> IF APPLICABLE: ❑OUTSIDE CITY LIMITS 0 BUILDING AREA <br /> SF ❑LOT# <br /> BUILDING TYPE: SFR-DETACHED ❑SFR-ATTACHED ❑DULEX ❑MULTI-FAMILY#OF UNITS: ❑COMMERCIAL ❑INDUSTRIAL <br /> CHANGE OF USE? .gr NO ❑YES, FROM <br /> TO <br /> :UTILITY APPLICATAOAI INFORMATION <br /> SEWER(check all that apply) WATER(check all that apply) <br /> SIDE SEWER REPAIR ❑NEW WATER SERVICE INSTALLATION <br /> ❑SIDE SEWER ALTERATION <br /> 0 COMPLE I E SERVICE 0 METER ONLY <br /> ❑NEW SIDE SEWER INSTALLATION SERVICE/METER USE: <br /> 0 INSTALL BACKWATER VALVE(outside the building) ❑SFR <br /> ❑SIDE SEWER CAP-OFF <br /> 0 MULTI-FAMILY-#CF UNITS: <br /> ❑SIDE SEWER RECONNECTION <br /> 0 COMMERCIAL <br /> MULTIPLE DOMESTIC WATER SERVICES REQUEST <br /> WATER SERVICE TYPE/SIZE: (circle desired size) <br /> II I AM DECLINING MULTIPLE DOMESTIC WATER SERVICES FOR 0 DOMESTIC: i <br /> MY MULTI-FAMILY DEVELOPMENT UNDER SINGLE OWNERSHIP. /4", 1", 2", OTHER: <br /> C71RR1GATION: 33/4", 1", <br /> 2", OTHER: <br /> ❑ I AM OPTING TO INSTALL MULTIPLE DOMESTIC WATER El FIRE: 1", 2", 4", <br /> SERVICES FOR MY MULTI-FAMILY DEVELOPMENT UNDER 6", ", OTHER: <br /> SINGLE OWNERSHIP.FILL OUT REVERSE SIDE OF THIS FORM. ❑DOMESTIC/FIRE COMBO: 1", 2", OTHER: <br /> - CONTACT INFORMATIdN <br /> OWNER NAME: 7f 0 be r 1 Co TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET Lf?/,- . --ST)U YA.el r9 v� <br /> ern' ,aVAT: ' Qv�03' <br /> STATE ��, � 7..1P <br /> OWNER PHONE: /J ;o / _iks,7 OWNER EMAIL: <br /> . /6 <br /> .. . �. .. _ .. <br /> ... ....._ _.. .� . _ <br /> .. ... .. . _.. V _ <br /> . . ... .. v.. .,... <br /> CONTRACTOR NAME: H <br /> CONTRACTOR ADDRESS: STREET J <br /> ID eek 6-6 a 7 <br /> CrlY fC ves I r STATE yvCP . zip9 tJ(.., <br /> CONTRACTOR PHONE:',Q �b-7? Q f?/ !CONTRACTOR EMAIL:/i ( i& 7'` ,1 in bit 19-2_ e��p Mlle -,Ct^sY� <br /> CONTRACTOR-LIG.#(REgUiRED):�� Q 14Zc�(' 5" <br /> -~�-- •--�.----- �/ !CITY OF EVERETT BUSINESS LJC_ YREQUIRE <br /> PRIMARY CONTACT: ❑OWNER i2 CONTRACTOR 0 OTHER(Please Specify) _....._. <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> AGREEMENT:The undersigned applicant agrees to comply with all provisions of the Everett Municipal Code Title <br /> 14 Water and Sewer or such other rules and regulations now existing or which may be established from time to C.rty of Everett Official Use Only <br /> time. The applicant further agrees, as a condition precedent to receiving service that the utilities division shall have FEE <br /> the right at any time,without notice,to shut off or turn on the water supply for repairs,construction,and <br /> nonpayment of charges or for any other reasonable cause.I am the owner,or I am authorized by the owner of this �� <br /> property to perform the work fcr which application is made,and 1 comply with the State Contractors Law 18.27 <br /> ROW and 296.200A WAC. PERMIT* <br /> I U 2-002 b D5 <br /> ,,,e6,,,,,.., ,, D... <br /> Owner/Authorized ntSig nature I Date <br /> (Revised 90/1212015) _1 <br />