3128 COLBY AVE 2020-08-27 - Laserfiche WebLink

@OTT WATER I SEWER UTILITY APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 I FAX 425-257-8857 I (E) everetteps@everettwa.gov www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: iv,12.B CRL1 '1 AVE E1IEFTT,v4fl 6f2_0t IF APPLICABLE: ❑OUTSIDE CITY LIMITS 0 BUILDING AREA SF 0 LOT# BUILDING TYPE: ❑SFR ❑TOWNHOUSE ❑DUPLEX ❑ADU ❑MULTI-FAMILY-#OF UNITS: COMMERCIAL ❑ACCESSORY CHANGE OF USE? Icy 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 ❑SIDE SEWER ALTERATION 0 COMPLETE SERVICE ❑METER ONLY 0 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 ❑DOMESTIC: 03/4" ❑1" 02" ❑Other: MY MULTI-FAMILY DEVELOPMENT UNDER SINGLE OWNERSHIP. ❑ IRRIGATION: 03/4" 01" 02" ❑Other: ❑ I AM OPTING TO INSTALL MULTIPLE DOMESTIC WATER 0 FIRE: ❑1" 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. ❑BACKFLOW PREVENTION(Outside): ❑RPBA ❑DCDA ❑DCVA CONTACT INFORMATION OWNER NAME: CYIYiS NA(kW\� C6YITUitk TNT st TENANT BUSINESS NAME(If Commercial): Attlamc4 Dt,n an,Inc.j i OWNER MAILING ADDRESS: STREET 3 2_ Nei CITY ('e STATE ZIP q82.131 OWNER PHONE:(112c)?551 - {, OWNER EMAIL: �ioktr,.Werci 1GG GilalnS itk 1�p1'LS,COY\ CONTRACTOR NAME: (,ilVtY� -CY% Oft- LLC NA. {�yA rSe.wer W�YrDl,\n \J CONTRACTOR ADDRESS: STREET --Pb �t ( 5e35-1-3 CITY \ONit,1r, STATE ' ZIP q8 IS5 CONTRACTOR PHONE: 2jb—g3)— 1 ZS CONTRACTOR EMAIL: () k�, @ ONASPVSPr C:hrr CONTRACTOR LIC.#(REQUIRED):11145 ‘4311QlYJ-.2*6 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): ��2 PRIMARY CONTACT: VOWNER COCONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 2_010-(-13\ 1 "c lc1\ i'n t\N\p\ CONTACT EMAIL: S�eY1Ce @ no Sewer,C Ow\ 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.tam the owner,or t am authorized by the owner of this property to perform the work for which application is made,and t comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PERMIT# �►/ �S"�il,� 2�)1 U —00A 1 Owner/A horized Agent S •nature Date (Revised 10/12/2018)