5718 LOMBARD AVE 2020-07-14 - Laserfiche WebLink

WATER / SEWER UTILITY APPLICATION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT.WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 5718 LOM0ARD AVE EVERETT WA 98203 IF APPLICABLE: ❑OUTSIDE CITY LIMITS ❑ BUILDING AREA SF ❑LOT# BUILDING TYPE: EJSFR ❑TOWNHOUSE ❑DUPLEX `❑ADU EMULTI-FAMILY-#OF UNITS: ❑COMMERCIAL ❑ACCESSORY: CHANGE OF USE? U NO Ll YES, FROM TO UTILITY APPLICATION INFORMATION SEWER (check all that apply) WATER (check all that apply) ❑✓ SIDE SEWER REPAIR ❑NEW WATER SERVICE INSTALLATION ❑SIDE SEWER ALTERATION ❑COMPLETE SERVICE ❑METER ONLY ❑NEW SIDE SEWER INSTALLATION SERVICE/METER USE: Li INSTALL BACKWATER VALVE(outside the building) ❑SFR ❑SIDE SEWER CAP-OFF El MULTI-FAMILY-#OF UNITS: ❑SIDE SEWER RECONNECTION ❑COMMERCIAL MULTIPLE DOMESTIC WATER SERVICES REQUEST WATER SERVICE TYPE/SIZE:(provide calcs to support size choice) Li I AM DECLINING MULTIPLE DOMESTIC WATER SERVICES FOR Li DOMESTIC: 03/4" 01" 02" ❑Other: MY MULTI-FAMILY DEVELOPMENT UNDER SINGLE OWNERSHIP. Li IRRIGATION: 03/4" 01" 02" ❑Other ❑I AM OPTING TO INSTALL MULTIPLE DOMESTIC WATER I...I FIRE: 01" 02" 04" [16" 08" ❑Other SERVICES FOR MY MULTI-FAMILY DEVELOPMENT UNDER ❑DOMESTIC/FIRE COMBO: 01" 02" ❑Other: SINGLE OWNERSHIP.FILL OUT REVERSE SIDE OF THIS FORM. ❑BACKFLOW PREVENTION (Outside): ❑RPBA EDCDA EDCVA CONTACT INFORMATION OWNER NAME: GLORIA MARTIN TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: sTREEr5718 LOMBARD AVE C1TY EVERETT STATE WA ZIP 98203 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME:APOLLO PLUMBING LLC CONTRACTOR ADDRESS: STREETP.O. BOX 53 cry EVERETT STATE WA ZIP 98206 CONTRACTOR PHONE:425-387-1507 CONTRACTOR EMAIL:DEBBEI@APOLLOPLUMBING.COM CONTRACTOR LIC.#(REQUIRE_D):APOLLPL9O3LT CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 053455 PRIMARY CONTACT: LI OWNER ❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:425-449-6325 COREY WEGNER CONTACTEMAIL:debble@ap011OpIUmbing.COm 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- 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 r am 'zed by the owner of this i mperiy to perforin 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 ji . PERMIT# ' ( ' 10/24/19 U 1.,C:1\ \� +-- o4 Owner/Authorized Agent Signature Date (Revised 10/12/2018)