1515 PALM AVE 2020-07-14 - Laserfiche WebLink

1111 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 ADDRESS: 1515 Palm Ave IF APPLICABLE: 0 OUTSIDE CITY LIMITS 0 BUILDING AREA SF 0 LOT# BUILDING TYPE: ❑SFR ❑TOWNHOUSE ❑✓DUPLEX ❑ADU ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL ❑ACCESSORY CHANGE OF USE? El NO ❑YES, FROM TO Z.;S fi C ak _ a=ir<r, j SEWER(check all that apply) WATER(check all that apply) ❑✓ SIDE SEWER REPAIR 0 NEW WATER SERVICE INSTALLATION 0 SIDE SEWER ALTERATION 0 COMPLETE SERVICE 0 METER ONLY 0 NEW SIDE SEWER INSTALLATION SERVICE/METER USE: ❑INSTALL BACKWATER VALVE(outside the building) 0 SFR 0 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: ❑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 OWNER NAME John T Baker TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: sTREEr4705 75th ST SW an, Mukilteo STATE WA ZIP 98275 OWNER PHONE:4252204226 OWNER EMAIL:johntbakeljr@comcast.net CONTRACTOR NAME:Dillon Aschenbrenner'"-ift 4'yx)ta of\ i..e.,- CONTRACTORADDRESS: STREEr5129 Everegreen Way Suite B PMB281 Everett, WA 98203 crtr Everett STATE Wa ap 98203 CONTRACTOR PHONE:425- 67- 1 CONTRACTOR EMAIL:indepthex@gmail.com CONTRACTOR LIC.#(REQUI o):604266466.-) CITY OF EVERETT BUSINESS LIC.#(REQUIRED Q 0 lk PRIMARY CONTACT: 0 OWNER l?I CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:425-367-1521 Dillon Aschenbrenner CONTACT EMAIL:Indepthex@gmail.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 maybe 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.lam the owner,or I am a by the owner of this properly to perform the 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 os, # er/Authorized Agent Signature Date (Revised 10/12/2018)