2105 JEFFERSON PL 2020-07-14 - Laserfiche WebLink

i.l. WATER / SEWER UTILITY APPLICATION is CITY OF EVERETT PERMIT SERVICES EVERETT 3200 CEDAR STREET, EVERETT,WA 98201 WASHINGTON (P)425-257-8810 1 FAX 425-257-8857 1 (E)everetteps@everettwa.govl www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 2105 Jefferson Ave Everett WA 98203 IF APPLICABLE: ❑ OUTSIDE CITY LIMITS ❑ BUILDING AREA SF ❑LOT# BUILDING TYPE: ❑✓SFR ❑TOWNHOUSE ❑DUPLEX ❑ADU ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL ❑ACCESSORY' CHANGE OF USE? ❑NO ❑YES, FROM TO UTILITY APPLICATION INFORMATION SEWER(check all that apply) WATER(check all that apply) C✓1 SIDE SEWER REPAIR ❑NEW WATER SERVICE INSTALLATION ❑SIDE SEWER ALTERATION ❑COMPLETE SERVICE ❑METER ONLY ❑NEW SIDE SEWER INSTALLATION SERVICE/METER USE: ❑ INSTALL BACKWATER VALVE(outside the building) ❑SFR ❑SIDE SEWER CAP-OFF ❑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 El DOMESTIC: 03/4" 01" 02" ❑Other: MY MULTI-FAMILY DEVELOPMENT UNDER SINGLE OWNERSHIP ❑ IRRIGATION: 03/4" 01" 02" ❑Other: ❑I AM OPTING TO INSTALL MULTIPLE DOMESTIC WATER ❑FIRE: ❑1" 02" 04" ❑e" ❑8" ❑Other: SERVICES FOR MY MULTI-FAMILY DEVELOPMENT UNDER ❑ DOMESTIC/FIRE COMBO: Ill" 02" ❑Other SINGLE OWNERSHIP. FILL OUT REVERSE SIDE OF THIS FORM. ❑BACKFLOW PREVENTION (Outside): ❑RPBA ❑DCDA ❑DCVA CONTACT INFORMATION 'OWNER NAME: Valari Nattier TENANT BUSINESS NAME If Commercial : OWNER MAILING ADDRESS: sTREET2105 Jefferson Ave . din. Everett STATE WA 711, 98203 OWNER PHONE:4253486848 OWNER EMAIL: CONTRACTOR NAME:SpOsarl inc. dba Mr. Rooter CONTRACTOR ADDRESS: sTREET2000 South 116th ST c1Tv Seattle STATE WA ZIP 98168 CONTRACTOR PHONE:206651 2917 CONTRACTOR EMAIL:Charlerlel@U mrrOOterSea.COm CONTRACTOR LIC.#(REQUIRED):MROOP*022NE CITY OF EVERETT BUSINESS LIC.#(REQUIRED: 038080 PRIMARY CONTACT: ❑OWNER Cl CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:206-651-2917 Charlene Lundgren CONTACT EMAIL:charlerlel p[@rn rooterSea.corn 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 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 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./em the owner,or 1 am authorrr rtowner of this property to�rft rm the work for which application is made,and I comply with the State Contractors Law 18.27 RCW and 298.200A WAC. / City of Everett Official Use Only PERM11 1 i tv '' ;' ' / . .>0-2,1_,,,,t) /AV/7 / U ) Dc — D'i D 1Qwfter/Authorlaed Agejst Sigttature ,` h5ate (Revised 10/12/2018) iy r