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WATER / SEWER UTILITY APPLICATION <br /> EVERETT CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> WASHINGTON (P)425-257-8810 1 FAX 425-257-8857 1 (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 2907 93rd Place SE Everett 98208 <br /> IF APPLICABLE: ❑✓ OUTSIDE CITY LIMITS ❑ BUILDING AREA SF ❑LOT#14 <br /> BUILDING TYPE: ❑✓SFR ❑TOWNHOUSE ❑DUPLEX ❑ADU ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL ❑ACCESSORY <br /> CHANGE OF USE? ll NO ❑YES, FROM TO <br /> UTILITY APPLICATION INFORMATION <br /> SEWER (check all that apply) WATER (check all that apply) <br /> ❑SIDE SEWER REPAIR ❑✓ NEW WATER SERVICE INSTALLATION <br /> ❑SIDE SEWER ALTERATION ❑COMPLETE SERVICE ❑✓ METER ONLY <br /> ❑✓ NEW SIDE SEWER INSTALLATION SERVICE/METER USE: <br /> ❑INSTALL BACKWATER VALVE(outside the building) ❑✓ SFR <br /> ❑SIDE SEWER CAP-OFF ❑MULTI-FAMILY-#OF UNITS: <br /> ❑SIDE SEWER RECONNECTION ❑COMMERCIAL <br /> MULTIPLE DOMESTIC WATER SERVICES REQUEST WATER SERVICE TYPE/SIZE: (provide calcs to support size choice) <br /> ❑✓ I AM DECLINING MULTIPLE DOMESTIC WATER SERVICES FOR ❑DOMESTIC: 03/4" 01" 02" ❑Other: <br /> MY MULTI-FAMILY DEVELOPMENT UNDER SINGLE OWNERSHIP. ❑ IRRIGATION: 03/4" 01" 02" ❑Other: <br /> ❑I AM OPTING TO INSTALL MULTIPLE DOMESTIC WATER ❑FIRE: 01" 02" 04" 06" 08" ❑Other: <br /> SERVICES FOR MY MULTI-FAMILY DEVELOPMENT UNDER ❑ DOMESTIC/FIRE COMBO: 01" ❑2" ❑Other: <br /> SINGLE OWNERSHIP. FILL OUT REVERSE SIDE OF THIS FORM. ❑BACKFLOW PREVENTION(Outside): ❑RPBA ❑DCDA ❑DCVA <br /> CONTACT INFORMATION <br /> OWNER NAME: Harbour Homes LLC TENANT BUSINESS NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET400 North 34th Street <br /> CITY Seattle STATE WA Z,R 98103 <br /> OWNER PHONE:(206) 31 5-81 30 OWNER EMAIL:Awirtz@harbourhomes.com <br /> CONTRACTOR NAME:Team Northwest Excavating <br /> CONTRACTOR ADDRESS: STREET 13930 State Route 9 NE <br /> c,y Arlington STATE WA zIp 98223-4973 <br /> CONTRACTOR PHONE:(425) 754-6500 CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED):603266421 001 0001 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 61239 <br /> PRIMARY CONTACT: ❑✓ OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:(425) 361-5797 <br /> Austin Wirtz CONTACT EMAIL:AWIrtz@harbourhomeS.corn <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 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 /> Austin Wirtz rg;a s oe 9Y<:9 z5'oToa.aw--na,-'h°mas.c°m 8/19/19 U L14( 0 e (C) -� <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2018) <br />