2901 STATE ST 2020-06-05 - Laserfiche WebLink

• . MEI WATER / SEWER UTILITY APPLICATION "�'`I� CITY OF EVERETT PERMIT SERVICES E R E 1 3200 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa,gov I www.everettwa,gov/permits ST • R �EFT M;«# F.,» " " a ,. ,,..,te. � .. � ,„H ...,c.. , x . .. ,,,ti a...�:..• PROJECT ADDRESS: 2901 State Street Everett,WA 98201 IF APPLICABLE , ❑OUTSIDE CITY LIMITS 0 BUILDING AREA SF ❑LOT# BUILDING TYPE: ❑SFR ❑TOWNHOUSE ODUPLEX ❑ADU DMULTI-FAMILY-#OF UNITS: ❑✓CQMMERCIAL ❑ACCESSORY=, CHANGE OF USE? 0 NO ❑YES, FROM TO ''r 4? ' m UY4 I c4310: :RMIttO1 Ile*-t7 SEWER(check all that apply) WATER(check all that apply) r❑✓ SIDE SEWER REPAIR 0 NEW WATER SERVICE INSTALLATION 0 SIDE SEWER ALTERATION 0 COMPLETE SERVICE 0 METER ONLY 0 NEW SIDE SEWER INSTALLATION SERVICE/METER USE: 0 INSTALL BACKWATER VALVE(outside the building) 0 SFR 0 SIDE SEWER CAP-OFF 0 MULTI-FAMILY-#OF UNITS: ❑SIDE SEWER RECONNECTION 0 COMMERCIAL MULTIPLE DOMESTIC WATER SERVICES REQUEST WATER SERVICE TYPE/SIZE:(provide calcs to support size choice) ❑I AM DECLINING MULTIPLE DOMESTIC WATER SERVICES FOR 0 DOMESTIC: 03/4" 01" 02" ❑Other: MY MULTI-FAMILY DEVELOPMENT UNDER SINGLE OWNERSHIP, 0 IRRIGATION: 03/4" 01" 02" ❑Other: 0 I AM OPTING TO INSTALL MULTIPLE DOMESTIC WATER 0 FIRE: 01" 02" 04" 06" 08" ❑Other SERVICES FOR MY MULTI-FAMILY DEVELOPMENT UNDER 0 DOMESTIC/FIRE COMBO: 01" 02" ❑Other: SINGLE OWNERSHIP.FILL OUT REVERSE SIDE OF THIS FORM. 0 BACKFLOW PREVENTION(Outside): DRPBA ❑DCDA ❑DCVA. CONTA T II 'ORNMA1IO1 OWNER NAME:,Grange Supply Inc TENANT BUSINESS NAME(If Commercial):Co-Op Everett OWNER MAILING ADDRESS: sTREET2901 State St cnv Everett STATE WA ZIP 98201 OWNER PHONE:360-659-1236 Ext 206 jOWNER EMAIL:rickn@co-opsuppl-inc.com �. CONTRACTOR NAME:Mr. Rooter Plumbing CONTRACTOR ADDRESS: sIREET2000 South 116th St cnv Seattle STATE WA ZIP 98168... CONTRACTOR PHONE:206-651-2917 CONTRACTOR EMAIL:Charlenei@mrrootersea.com CONTRACTOR LIC.#(REQUIRED) MRROOP*022NE CITY OF EVERETT BUSINESS LIC.#REQUIRED): 038080 PRIMARY CONTACT: 0 OWNER D✓ CONTRACTOR 0 OTHER(Please Specify). CONTACT NAME: CONTACT PHONE:206-651-2917 Charlene Lundgrena 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 Qni. : OERMI' # • A 1't l l . 0t2'/s 1Authorized Agent Skgrt Date (Revised 10/12/2018)