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■m WATER / SEWER UTILITY APPLICATION <br /> in <br /> EVERETT CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwagov/permits <br /> PROJECT SITE INFORMATION W <br /> PROJECT ADDRESS: 2517 74th Place SE Everett WA 98203 <br /> IF APPLICABLE: ❑ OUTSIDE CITY LIMITS ❑ BUILDING AREA SF ❑LOT# <br /> BUILDING TYPE: ❑✓SFR ❑TOWNHOUSE EDUPLEX EADU ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL ❑ACCESSORY <br /> CHANGE OF USE? ❑NO ❑YES, FROM TO <br /> ;:illi <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: ❑3/4" CI 1" 02" ❑Other: <br /> MY MULTI-FAMILY DEVELOPMENT UNDER SINGLE OWNERSHIP. ❑ IRRIGATION: ❑3/4" ❑1" ❑2" ❑Other: <br /> ❑I AM OPTING TO INSTALL MULTIPLE DOMESTIC WATER ❑FIRE: ❑1" 02" 04" ❑s" 08" ❑Other: <br /> SERVICES FOR MY MULTI-FAMILY DEVELOPMENT UNDER ❑ DOMESTIC/FIRE COMBO: ❑1" ❑2" ❑Other: <br /> SINGLE OWNERSHIP.FILL OUT REVERSE SIDE OF THIS FORM. ❑ BACKFLOW PREVENTION (Outside): ❑RPBA ❑DCDA ❑DCVA <br /> CONTACT INFORMATION <br /> OWNER NAME: Chris Uhl TENANT BUSINESS NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTREET251 7 74th Place Southeast <br /> CITY Everett STATE Wa ZIP 98203 <br /> OWNER PHONE:425-772-2075 'OWNER EMAIL: Chrrsuh6@aol.com <br /> CONTRACTOR NAME:SpOsarl Inc. dba Mr. Rooter Plumbing <br /> CONTRACTOR ADDRESS: sTREET2000 South 116th Street <br /> CITY Seattle STATE WA ZIP 98168 <br /> CONTRACTOR PHONE:2O6-651-2917 CONTRACTOR EMAIL:Charlenel p@mrrOOtersea.COm <br /> CONTRACTOR LIC.#(REQUIRED):MRROOP*022NE CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 038080 <br /> PRIMARY CONTACT: ❑OWNER ❑✓ CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:206-651-2917 <br /> Charlene Lundgren CONTACT EMAIL:charlenel@mrrootersea,com <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 /> / , <br /> City of Everett Official Use Only <br /> PERMIT#( {� k'� <br /> -',. Ititei3 .> j) 7/24/2019 U l- 1 V� v <br /> Owner/Authorized <br /> Ant Signatu e Date L\I <br /> (Revised 10/12/2018) <br /> 1 / <br />