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,Il , <br /> mss------��� WAR / SEWER UTILITY —LICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> ' 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I (E) everetteps@everettwa.gov ( www.everettwa.gov/permits <br /> Mk zr�.y��':a *��� �.. � _-vrs ��;�� f"� a�>-::_ l a� .<�a?, s.�a^..x.�.'t.`� � ;.��� ,.F .>�.-z-��.iv. �.:`�...a-��a:'�*�'cs 4`�,'2� c� -:�,."����.��::.F �,, �a� }r`:3,�_' <br /> -1 a d .3.'ti;;'i, .�'e rx.x't zk aa. ��'a�-. "_r.ig: :;it .n R.0 '.+� ?s 1 1 .,.�'�'..t�=`�'^ �c,s ..,ai::at a t. .� Z,i.` ew. <br /> PROJECT ADDRESS: L 0 22 c 1 5I y, S•C_ I_vett,*, I.J/\ R 8'L0 <br /> IF APPLICABLE: 0 OUTSIDE CITY LIMITS 0 BUILDING AREA SF NKr LOT# 2, <br /> BUILDING TYPE: ❑SFR ❑TOWNHOUSE ❑DUPLEX ❑ADU ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL ❑ACCESSORY: <br /> CHANGE OF USE? XNO ,0 YES, FROM TO <br /> v t t Y t::4� ^`chi �. 6� ��Hta.i,,.,�'L'4�� ,`�q .per �h,?�, o... . y,a,: .,wv i �-.a 2 �..�. <br /> v'' `^=4 ae: Y i::3'��a v�� cy� 1 e,�; '' to €tai w�+ g� s z w1 �,.:�� ..� �'�, ��`z x� �.; ..: <br /> .?:� ) ,a� u ��"Yr,?. v,� � ti. �' � '� s.. �'':cc �4� � �` S 4 � �a a�. �;�,�:. ;y��'ci yea'.��., ��'�ti: <br /> +,':.h�.,,��, �:..S.�i,..'.�...;�^� � �.?,.« x.3., �,pmk:.° ��'3�a�;;4�...x��. r„��4�`�s�� '3;��j c w.,� �. ,`� x c,'�. �C�,,:.-�r.. „��„ �. <br /> �K �<s„ ,.sb ��,, �x�, s ..��„ ,�",..�. .�"�. r��>�o��s. t� �. ss. �*-�rxa� s.'�,_ r��a���'?°i�.. ao°��.�.. � .,�a,a.� �r. , ��. <br /> SEWER(check all that apply) WATER(check all that apply) <br /> ❑SIDE SEWER REPAIR 9 Site-MS KNEW WATER SERVICE INSTALLATION <br /> ❑SIDE SEWER ALTERATION TIA] i 7o5.abO 'COMPLETE SERVICE 0 METER ONLY <br /> iti NEW SIDE SEWER INSTALLATION SERVICE/METER USE: <br /> ❑ INSTALL BACKWATER VALVE(outside the building) "SFR <br /> ❑SIDE SEWER CAP-OFF 0 MULTI-FAMILY-#OF UNITS: <br /> ❑SIDE SEWER RECONNECTION 0 COMMERCIAL <br /> MULTIPLE DOMESTIC WATER SERVICES REQUEST WATER SERVICE TYPE/SIZE: (provi,le calcs to support size choice) <br /> I AM DECLINING MULTIPLE DOMESTIC WATER SERVICES FOR fl DOMESTIC: ❑3/4" I:11” 02" ❑Other: <br /> [[1111���`MY MULTI-FAMILY DEVELOPMENT UNDER SINGLE OWNERSHIP. 0 IRRIGATION: 03/4" 01" 02" ❑Other: <br /> ❑ I AM OPTING TO INSTALL MULTIPLE DOMESTIC WATER 0 FIRE: 01" 02" 04" 06" 08" ❑Other: <br /> SERVICES FOR MY MULTI-FAMILY DEVELOPMENT UNDER (DOMESTIC/FIRE COMBO: Z'1" 02" ❑Other: <br /> SINGLE OWNERSHIP. FILL OUT REVERSE SIDE OF THIS FORM. 0 BACKFLOW PREVENTION(Outside): ❑RPBA ❑DCDA ❑DCVA <br /> `t a Y � ,...a„ Pa Va r.0N.t .`tt**t l i011�.11O ,'s M Mu kaa i a <br /> OWNER NAME: hiO t i�idt/ZSt i II olitt IAGLIS ..f./I C TENANT NAME(If Commercial): --. <br /> OWNER MAILING ADDRESS: STREET 4 tct I2.4k" S -. S.E, �j <br /> CITY G^VU''([�'t'4 STATE t,JA ZIP R p Z0 <br /> OWNER PHONE: Lits - 23°1, 411 Z..A OWNER EMAIL: Rod .Ct?YV\ <br /> CONTRACTOR NAME: ()WALT <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: %OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT-1 NAME: CONTACT PHONE: qty._-to ..qq 2`4 <br /> Za kdOr✓1 CONTACT EMAIL: Rof.c9cy,le u11vx i S LA - LO M <br /> 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 <br /> 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 <br /> 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 <br /> authorized by the owner of this property to erform the work for which application is made,and/comply with the State Contractors Law 18.27 RC W and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> S ' IC— ici U 16/.6-3-0(1 <br /> Owner/ orized Agent Signature Date (Revised 10/12/2018) <br />