|
WAR / SEWER UTILITY A_ LIGATION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> EVERETT 3200 CEDAR STREET, EVERETT, WA 98201
<br /> WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@everettwa.gov I https://everettwa.gov/permits
<br /> �`�. �.,! X Y>a. 5t s5 a� �p u„x:,M. -w�.i;z�..,o- ...<:;� ;Y+�.,::,sj*:ze, t.�:. .t%"`v °'x �'u`«aex=F�z��r�� �` S � a�:
<br /> '?w� iS� �.'�` z .��@ U,�:- `��, ��,.r y. � �..�� tea= F� aY�z� '2?�' �l�v{4< �;.;�`� w '�':
<br /> .L '.:. `` '� v 1 9 i 1 V E 'Z R t�..' T �i �o a�•':..FZ'+dR11 °.1 'tib^#1 x 4�.5 n`t 1 mac.. ¢ . ,p.
<br /> .. � � �- ,1�t, v.vu� �� `" a �s .�- .,g ., vim: e� .. � _� .���. ,,,K. ,� z. ��,�. ,evs�.;
<br /> PROJECT ADDRESS: �I-2:291 � 1 %+h Au'�. w Vere• � A �q� -7-01 ��
<br /> IF APPLICABLE: 0 OUTSIDE CITY LIMITS 0 BUILDING AREA SF 0 LOT#
<br /> BUILDING TYPE: JSISFR ❑TOWNHOUSE ODUPLEX ❑ADU ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL ❑ACCESSORY
<br /> CHANGE OF USE? ONO ❑YES, FROM TO
<br /> ';z.�� v � � �`� �.���: � �s� i. '�,� y.■�.�.� .y ,�,,�„�.':,�,`a � z�.:.,� r x�,�s�ygt��3����� �`� � °�''ffiv `” �- y*T ra-:.
<br /> a Z -vx2.kk1 11.111. 2 + 3 i ..a�: u Y t0IN=00 0.00 1111 '. 'wcy�tai;.1 2.e .. . 3 5:.,�`
<br /> ;t.k,?....>. .':� 'zd ;>.. z+��s,.� �,�.,''.:>+u�'�,...>:.Vis.kv�R 1,4��,�1P�". ,.�. mz',,::,�e?.r '.:?',�..�. r��,�i� ���"'v`�u ...`.ax ;.���t.',�F�.�N.�v?. �:,a..� �... � �... .nv ., ? ...,.:i
<br /> SEWER(check all that apply) WATER(check all that apply)
<br /> ❑SIDE SEWER REPAIR NEW WATER SERVICE INSTALLATION
<br /> ❑SIDE SEWER ALTERATION 14 COMPLETE SERVICE 0 METER ONLY
<br /> ❑ NEW SIDE SEWER INSTALLATION SERVICE/METER USE:
<br /> ❑ INSTALL BACKWATER VALVE(outside the building) 93 SFR
<br /> ❑SIDE SEWER CAP-OFF , ❑MULTI-FAMILY-#OF UNITS:
<br /> ❑SIDE SEWER RECONNECTION 0 COMMERCIAL
<br /> MULTIPLE DOMESTIC WATER SERVICES REQUEST WATER SERVICE TYPE/SIZE:(provide calcs to support size choice)
<br /> O I AM DECLINING MULTIPLE DOMESTIC WATER SERVICES FOR J DOMESTIC: 1" 02" ❑Other:
<br /> 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 0 DOMESTIC/FIRE COMBO: 01" 02" ❑Other:
<br /> SINGLE OWNERSHIP. FILL OUT REVERSE SIDE OF THIS FORM. 0 BACKFLOW PREVENTION(Outside): ❑RPBA ❑DCDA ❑DCVA
<br /> c
<br /> r1
<br /> OWNER NAME: S+C,Wof N 016 c/ ® r; RtxnelENANT BUSINESS NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET • • la .)( J A
<br /> CITYSA-4 nwQCA STATEV) c\ ZIP` 11OWNER PHONE:61-5 2'16 1 ( OWNER EMAIL. 5 ' OtANO a
<br /> CONTRACTOR NAME: 7) +' 7Q1-6- ?`i -34//\ t -1/1 is 1.2.3-0A05<___
<br /> CONTRACTOR ADDRESS: STREET /& /1 LJ-/� 1.3
<br /> CITY C.VM.1 We* STATE ire/1 ZIP
<br /> CONTRACTOR PHONE: 42.6 7 7i'6!/Cif CONTRACTOR EMAIL: (. �v 1 e. ��I�L ?>v r� , ,o NC+
<br /> CONTRACTOR LIC.#(REQUIRED): p4')Av hy.b s CITY OF EVERETT BUSINESS LIC.#(REQUIRED): C
<br /> PRIMARY CONTACT: jgOWNER 0 CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: 4.2-44 �j,,5L7 I Z
<br /> /l TZ, > /6-1 CONTACT EMAIL: 1 » e_14,4-14.14.‘1) ,cc544'N
<br /> AGREEMENT.The undersigned applicant agrees to comply with all provisions of the Everett Municipal Code Title 14 Water and Sewer or such ofher 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,ort am
<br /> 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.
<br /> City of Everett Official Use Only
<br /> PERMIT#
<br /> . g i . `9,o1- 2C0
<br /> *Authorized r/Authorized A Si! atur. Date (Revised 4/15/2019)
<br />
|