7702 RAINIER DR 2020-07-15 - Laserfiche WebLink

. Lui i• WATER / SEWER UTILITY APPLICATION 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.gov 1 https://everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 7 7 C' 2 — ,c 1 .t9g E:1,` /'? IF APPLICABLE: 0 OUTSIDE CITY LIMITS 0 BUILDING AREA SF 0 LOT# BUILDING TYPE: ES//FR OTOWNHOUSE ❑DUPLEX ❑ADU ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL ❑ACCESSORY CHANGE OF USE? 19/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 BIDE SEWER ALTERATION 0 COMPLETE SERVICE 0 METER ONLY ❑ NEW SIDE SEWER INSTALLATION SERVICE/METER USE: O 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: /7iO✓/- `% V67/2-/ BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 7'7 0 Z -- /2c 1 fZt -ems L7/'? .-, �J '-.2-0 CITY t.::-...1 '[/ `��/�� STATE e;' ZIP G' 3 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: 4 /// 2 C41 U- Lc11--C/� /2.7o p/ L Z' ,��C_9 /litre /17 r . CONTRACTOR ADDRESS: STREET %2 9/ 2, 9 Pc �`� CITY l/ L' ia; y - n,fir' STATE ( r-,4 ZIP 9A `-� CONTRACTOR PHONE: 7 .a' 5-- Z'D- Y?76 CONTRACTOR EMAIL: P VG e) ,47/ e��Gva�-SP F' Gcn.�. CONTRACTOR LIC.#(REQUI ED): A t t 1 bc- L /2��,1�f CITY OF EVERETT BUSINESS LIC.#(REQUIIRRED): PRIMARY CONTACT: OWNER 0 CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: `-/ - 5---- /2-6o — Lj 7 /0( L / / 7 2/7 CONTACT EMAIL: /7C L �� /¢/�Q��(i �I e'OFe CCP/e.- AGREEMENT:The undersigned applicant agrees to coall provisions of the Everett Municipal Code Title 14 Water and Sewer or such o er rules and regulations now existing or which may be established from time to time. icant 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 tum.- e 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 owner of this propert o pe,t orm the work for which application is made,andI comply with the State Contractors Law 18.27 RCW and 296.200A WAC. C_�` / City of Everett Official Use Only 1 /_ /'� 9 PERMIT# U \11 C(17 6.34 Owner/Authorized Agent Signat re Date (Revised 4/15/2019)