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WATE / SEWEES. UTILITY APPLICATIO, ,). <br /> CIVERETPSE <br /> 3200 CEDAR <br /> ESTREETT, EVERETTERMIT ,RVICES WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION • <br /> PROJECT ADDRESS: ) .7)S 4. 6 3( , S+_ S� <br /> IF APPLICABLE: 0 OUTSIDE CITY LIMITS 0 BUILDING AREA SF 0 LOT# <br /> BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED DDULEX DMULTI-FAMILY-#OF UNITS: DCOMMERCIAL DINDUSTRIAL <br /> CHANGE OF USE? 0 NO 0 YES, FROM TO <br /> UTILITY APPLICATION INFORMATION <br /> SEWER(check all that apply) WATER(check all that apply) <br /> SIDE SEWER REPAIR 0 NEW WATER SERVICE INSTALLATION <br /> 0 SIDE SEWER ALTERATION 0 COMPLETE SERVICE 0 METER ONLY <br /> 0 NEW SIDE SEWER INSTALLATION SERVICE/METER USE: <br /> 0 INSTALL BACKWATER VALVE(outside the building) 0 SFR <br /> 0 SIDE SEWER CAP-OFF 0 MULTI-FAMILY-#OF UNITS: <br /> 0 SIDE SEWER RECONNECTION 0 COMMERCIAL <br /> MULTIPLE DOMESTIC WATER SERVICES REQUEST WATER SERVICE TYPE/SIZE:(circle desired size) <br /> 0 I AM DECLINING MULTIPLE DOMESTIC WATER SERVICES FOR 0 DOMESTIC: 3/4", 1", 2", OTHER: <br /> MY MULTI-FAMILY DEVELOPMENT UNDER SINGLE OWNERSHIP. 0 IRRIGATION: 3/4", 1", 2", OTHER: <br /> 0 I AM OPTING TO INSTALL MULTIPLE DOMESTIC WATER 0 FIRE: 1", 2", 4", 6", 8", OTHER: <br /> SERVICES FOR MY MULTI-FAMILY DEVELOPMENT UNDER 0 DOMESTIC/FIRE COMBO: 1", 2", OTHER: <br /> SINGLE OWNERSHIP.FILL OUT REVERSE SIDE OF THIS FORM. <br /> CONTACT INFORMATION <br /> OWNER NAME: TY-,Yl i ,f lO Je..r\ TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET S 19 Y"Z <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: eo fe���C <br /> CONTRACTOR ADDRESS: STREET /o6S-5 /C-k'~' I)a ., 4- is cL // <br /> cny T..,_fy/lla, STATE L� (� <br /> ` ZIP n 3 <br /> CONTRACTOR PHONE: Y7.1--- 3 Y6- )Z'7 CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): Rc$7 ,t'5c ( 2 z CITY OF EVERETT BUSINESS LIC.#(REQUIRE I : Q'17 Z I/ <br /> PRIMARY CONTACT: D OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: L/-FS---3,16 CXR Z `� <br /> K C ) 3 CONTACT EMAIL: <br /> AGREEMENT:The undersigned applicant agrees to comply with all provisions of the Everett Municipal Code Title City of Everett Official Use Only <br /> 14 Water and Sewer or such other rules and regulations now existing or which may be established from time to FEE <br /> time.The applicant further agrees,as a condition precedent to receiving service that the utilities division shall have /�\ �e�---- <br /> the right at any time,without notice,to shut off or turn on the water supply for repairs,construction,and <br /> �`/) <br /> nonpayment of charges or for any other reasonable cause.lam the owner,or!am authorized by the owner of this <br /> property to perform t - ork for which applic. n is made,and!comply with the State Contractors Law 18.27 PERMIT# <br /> RCW and 296. s'A L . I/ 4 U 1St <br /> ^t 0 <br /> Owner/Au orized/Agent Signature ate (Revised 10/12/2015) <br />