6504 HIGHLAND DR 2020-07-14 - Laserfiche WebLink

WATER / SEWER UTILITY APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETT 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 I FAX 425-257-8857 I (E) everetteps@everettwa.gov I https://everettwa.gov/permits WASHINGTON PROJECT SITE INFORMATION PROJECT ADDRESS: 6S(pi iilylalo`J.d. Z c CJC c II)a• q8 cLO 3 IF APPLICABLE: 0 OUTSIDE CITY LIMITS 0 BUILDING AREA SF 0 LOT# BUILDING TYPE: ❑SFR ❑TOWNHOUSE ODUPLEX ❑ADU ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL ❑ACCESSORY CHANGE OF USE? ANO 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 O 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 0 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: O I AM OPTING TO INSTALL MULTIPLE DOMESTIC WATER 0 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 ❑DCDA ❑DCVA CONTACT INFORMATION OWNER NAME: G U Nct f,\` TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET /-I ISki Gy‘ °- c :o'1 C 4 Z. CITY '7 STATE o/ ZIP c/8-70 3 OWNER PHONE: 112S n? ( I ` J ,� OWNER EMAIL: 6 Vy �(\C .('k S 1 Db ,tyko., k 'CC'-' ?., CONTRACTOR NAME: D i'A. CAA.0-1 f , r\ C : CONTRACTOR ADDRESS: STREET I(hi7 1 i-I (J,O) 9 9 )q 2 I 2 CITY (— V,,.3 CO a, STATE WCA, ZIP tl 8 ., 6 CONTRACTOR PHONE: 7J 164-01 IMS-2, CONTRACTOR EMAIL: iii I tot 0.C4 civv\ei I l . (.....on 1N CONTRACTOR LIC.#(REQUIRED): 'D la TCC.i 0.- b 6T CITY OF EVERETT BUSINESS LIC.#(REQUIRED):A PRIMARY CONTACT: 0 OWNER aCONTRACTOR 0 OTHER(Please Specify) q CONTACT NAME: ` CONTACT PHONE: '.©C' A .>( VI 2 3 hy1 C•� I C.---ext\RI-q,`I- CONTACT EMAIL: 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 existing or which may::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 any time,without n.ice, o 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•wner•'f 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. City of Everett Official Use Only PERMIT ��61 �,i/1l 0C - , U O Ow-4j AFr Age wig ature Da (Revised 4/15/2019)