1824 74TH ST SE 2020-06-18 - Laserfiche WebLink

WATER 6 SEWER UTILITY APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 I FAX 425-257-8857 1 (E)everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: \%),%-‘ 11/4-14 - S1 , Ct;Fy-r-r WA "I 9 a Q3 IF APPLICABLE: 0 OUTSIDE CITY LIMITS 0 BUILDING AREA SF 0 LOT# BUILDING TYPE: 1'SFR ❑TOWNHOUSE ❑DUPLEX ❑ADU ❑MULTI-FAMILY-#OF UNITS: OCOMMERCIAL ❑ACCESSORY, CHANGE OF USE? &I-NO 0 YES, FROM TO UTILITY APPLICATION INFORMATION SEWER (check all that apply) WATER(check all that apply) 'SIDE SEWER REPAIR 0 NEW WATER SERVICE INSTALLATION ❑SIDE SEWER ALTERATION 0 COMPLETE SERVICE 0 METER ONLY ❑NEW SIDE SEWER INSTALLATION SERVICE/METER USE: ❑ INSTALL BACKWATER VALVE(outside the building) 0 SFR ❑SIDE SEWER CAP-OFF 0 MULTI-FAMILY-#OF UNITS: ❑SIDE SEWER RECONNECTION ❑COMMERCIAL MULTIPLE DOMESTIC WATER SERVICES REQUEST WATER SERVICE TYPE/SIZE: (provide calcs to support size choice) ❑ I AM DECLINING MULTIPLE DOMESTIC WATER SERVICES FOR 0 DOMESTIC: 03/4" 01" 02" ❑Other: MY MULTI-FAMILY DEVELOPMENT UNDER SINGLE OWNERSHIP. 0 IRRIGATION: 03/4" 01" 02" ❑Other: ❑ I AM OPTING TO INSTALL MULTIPLE DOMESTIC WATER ❑FIRE: 01" 02" 04" 06" 08" ❑Other: SERVICES FOR MY MULTI-FAMILY DEVELOPMENT UNDER 0 DOMESTIC/FIRE COMBO: 01" 02" ❑Other: SINGLE OWNERSHIP.FILL OUT REVERSE SIDE OF THIS FORM. 0 BACKFLOW PREVENTION(Outside): ❑RPBA ODCDA ❑DCVA CONTACT INFORMATION OWNER NAME: (A'i }`( M4-2._ TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET t%a-1 794- vi Sf_ CITY f7:44.i .cAT- STATE 6.3/4- ZIP 9Sv3 OWNER PHONE: 1/d — (.2)S5--- j(, 7 S OWNER EMAIL: GA=r y IL1f_T-za'�a) ( , CONTRACTOR NAME: )L'OT ?L00-iI IAJ 6 CONTRACTOR ADDRESS: STREET 4{/a 41 t7 SJ'f _44„/Ar.-7CITY Si 'z STATE tu/A- ZIP '7giO3 CONTRACTOR PHONE: 2 a,-6,33-/700 CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED): J T AG L 972 CLJ CITY OF EVERETT BUSINESS LIC.#(REQUIRED):'— q y C' , PRIMARY CONTACT: 0 OWNER XCONTRACTOR 0 OTHER(Please Specify) CONTACT KIPV1 CONTACT PHONE: D up- 9 0J-6626/ ACJ is- CONTACT EMAIL: AGREEMENT T e and rsign d applicant agrees to comply with all provisions of the Everett Municipal Code Title 14 Water and Sewer or such other rules and regulations now existing r whic may b esta ished 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 tim , vithou lotice to sh t 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 author' c by th owne of th 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. City of Everett Official Use Only (1(A/ • 1 �/ PERMITU 1q D — 01D Owneuthorized A nt Signature Date (Revised 10/12/2018)