2814 HEWITT AVE NOODLE NATION 2022-02-11

WATER / SEWER UTILITY APPLICATION (P) 425-257-8810 CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: L4,W IF APPLICABLE: ❑ OUTSIDE CITY LIMITS ❑ BUILDING AREA SF ❑ LOT # BUILDING TYPE: ❑SFR ❑TOWNHOUSE ❑DUPLEX ❑ADU []MULTI -FAMILY-# OF UNITS: COMMERCIAL ❑ACCESSORY CHANGE OF USE? NO ❑ YES, FROM TO UTILITY APPLICATION INFORMATION SEWER (check all that aDDly) I WATER (check all that apply) SIDE SEWER REPAIR ❑ SIDE SEWER ALTERATION ❑ NEW SIDE SEWER INSTALLATION ❑ INSTALL BACKWATER VALVE (outside the building) ❑ SIDE SEWER CAP -OFF ❑ SIDE SEWER RECONNECTION MULTIPLE DOMESTIC WATER SERVICES REQUEST ❑ 1 AM DECLINING MULTIPLE DOMESTIC WATER SERVICES FOR MY MULTI -FAMILY DEVELOPMENT UNDER SINGLE OWNERSHIP ❑ I AM OPTING TO INSTALL MULTIPLE DOMESTIC WATER SERVICES FOR MY MULTI -FAMILY DEVELOPMENT UNDER SINGLE OWNERSHIP. FILL OUT REVERSE SIDE OF THIS FORM. ❑ NEW WATER SERVICE INSTALLATION ❑ COMPLETE SERVICE ❑ METER ONLY SERVICE / METER USE: ❑ SFR ❑ MULTI -FAMILY - # OF UNITS: ❑ COMMERCIAL WATER SERVICE TYPE / SIZE: (provide calcs to support size choice) ❑ DOMESTIC: 113/4" 1:11" ❑2" ❑Other: ❑ IRRIGATION: 113/4" 01" ❑2" []Other: ❑ FIRE: ❑1" ❑2" ❑4" ❑6" ❑8" []Other: ❑ DOMESTIC/FIRE COMBO: ❑1" 02" ❑Other : ❑ BACKFLOW PREVENTION (Outside): ❑RPBA ❑DCDA ❑DCVA CONTACT INFORMATION OWNER NAME: TENANT BUSINESS NAME (If Commercial): OWNER MAILING ADDRESS: STREET CITY STATE ZIP OWNER PHONE: OWNER EMAIL: ``11 CONTRACTOR NAME: C. ^ C 'CIO `v CONTRACTOR ADDRESS: STREET `C> O G�j 1 CITY f5o& STATE W • / ZIP CONTRACTOR PHONE: Z' 91 CONT�'RA,CTOR EMAIL: CONTRACTOR LIC. #(REQUIRED): FC r,C3 4 f /A�`W CITY OF EVERETT BUSINESS LIC. #(REQUIRED): PRIMARY CONTACT: ❑ OWNER CONTRACTOR ❑ OTHER (Please Specify) CONTACT NAME: C1'G CONTACT PHONE: CONTACT EMAIL: �"v r+ C W\ AGREEMENT: The undersigned applicant agrees to comply with all provisions of the Everett MunicipW'Code Title 14 Water and`Mfwer or such other ?ties 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 s 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 s o, any 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 PIERBMIT # V Ow /A on g ignature Date (Revised 1011212018)