3623 HOYT AVE 1-3 2020-06-17 - Laserfiche WebLink

WATER I SEWER. UTIIJTY APPUCAT O CITY OF EVERETT PERMIT SERVICES rl` 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 I FAX 425-257-8857 I (E) everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION I PROJECT ADDRESS: 3 G 2...3 FAY?' A-V E IS 20 i IF APPLICABLE: ❑ OUTSIDE CITY LIMITS 0 BUILDING AREA SF 0 LOT# BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ODULEX LMULTI-FAMILY-#OF UNITS: 3 ❑COMMERCIAL [INDUSTRIAL CHANGE OF USE? 0 NO 0 YES, FROM TO UTILITY APPLICATION INFORMATION SEWER(check all that apply) WATER(check all that apply) ❑ SIDE SEWER REPAIR (NEW WATER SERVICE INSTALLATION O SIDE SEWER ALTERATION IS(COMPLETE SERVICE 0 METER ONLY ❑ NEW SIDE SEWER INSTALLATION SERVICE/METER USE: ❑ INSTALL BACKWATER VALVE(outside the building) 0 SFR O SIDE SEWER CAP-OFF MULTI-FAMILY-#OF UNITS: ❑ SIDE SEWER RECONNECTION 0 COMMERCIAL MULTIPLE DOMESTIC WATER SERVICES REQUEST WATER SERVICE TYPE/SIZE: (circle desired size) O I AM DECLINING MULTIPLE DOMESTIC WATER SERVICES FOR 0 DOMESTIC: 3/4", 1", 2", OTHER: MY MULTI-FAMILY DEVELOPMENT UNDER SINGLE OWNERSHIP. 0 IRRIGATION: 3/4", 1", 2", OTHER: ❑ 1 AM OPTING TO INSTALL MULTIPLE DOMESTIC WATER ;FIRE: 0 2", 4", 6", 8", OTHER: SERVICES FOR MY MULTI-FAMILY DEVELOPMENT UNDER 0 DOMESTIC/FIRE�/ COMBO: 1", 2" OTHER: SINGLE OWNERSHIP. FILL OUT REVERSE SIDE OF THIS FORM. Sc E3aCk tLlti1(oUtsd6 bl81\) i :p4,.J 3S CONTACT INFORMATION. OWNER NAME: f..10•KUJ9E I S (NK aSTENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET 5? Ir � Qt. t) //Jj.� CITY /•1 1/+,v-1 l' e� WrYi E ZIP q$ /�] Y OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: CONTRACTOR ADDRESS: STREET • CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): PRIMARY CONTACT: [ OWNER 0 CONTRACTOR ❑ OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 500-- — F66 ,— 2 D & D .SOR\K)j)F _ S IDHk CONTACT EMAIL: 5U1 NDF SIIi-fU @ M YhLa(,,IJ` c", AGREEMENT::The undersigned applicant agrees to comply with all provisions of the Everett Municipal Code Title City of Everett Official Use Only 14 Water and Sewer or such other rules and regulations now existing or which may be established from time to FEE 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 wcrc_, k r which application is made,and I comply with the State Contractors Law 18.27 PERMIT# RCW and 29.. •iA WAC I I 1 U 17)09 ._�`./1s -.111111 Owner/Au . e.IAAgent Signature ate (Revised 10/12/2015)