3501 UPLAND AVE 2020-09-08 - Laserfiche WebLink

477. WATER / 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 I www.everettwa.gov/permits /1_ PROJECT ADDRESS: '55O I VP(f IF APPLICABLE: 0 OUTSIDE CITY LIMITS 0 BUILDING AREA SF 0 LOT# BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑DULEX ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL DINDUSTRIAL CHANGE OF USE? 0 NO 0 YES, FROM TO UTILITY 40:01#0,00:10-0,00:001.014 SEWER(check all that apply) WATER(check all that apply) ❑ SIDE SEWER REPAIR KNEW WATER SERVICE INSTALLATION ❑SIDE SEWER ALTERATION ;COMPLETE SERVICE 0 METER ONLY M'NEW SIDE SEWER INSTALLATION SERVICE/METER USE: ❑ INSTALL BACKWATER VALVE(outside the building) IS(SFR ❑SIDE SEWER CAP-OFF 0 MULTI-FAMILY-#OF UNITS: ❑SIDE SEWER RECONNECTION 0 COMMERCIAL MULTIPLE DOMESTIC WATER SERVICES REQUEST WATER SERVICE TYPE/SIZE: (circle desired size) ❑ I AM DECLINING MULTIPLE DOMESTIC WATER SERVICES FOR DOMESTIC: 1", 2", OTHER: MY MULTI-FAMILY DEVELOPMENT UNDER SINGLE OWNERSHIP. 0 IRRIGATION: 3/4", 1", 2", OTHER: ❑ I AM OPTING TO INSTALL MULTIPLE DOMESTIC WATER 0 FIRE: 1", 2", 4", 6", 8", OTHER: SERVICES FOR MY MULTI-FAMILY DEVELOPMENT UNDER 0 DOMESTIC/FIRE COMBO: 1", 2", OTHER: SINGLE OWNERSHIP. FILL OUT REVERSE SIDE OF THIS FORM. CONTACT INFORMATION OWNER NAME: 40.01,E„,E„ tem F$ - TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET `o(21/ `$OA az: <S6 �7 CITY 8/1)o h o mirk STATE 09 ZIP C$2G� / � OWNER PHONE: 4/R5-90 3 083 ! OWNER EMAIL: , CONTRACTOR NAME: 060 CONTRACTOR ADDRESS: STREET CITY STATEn �(� J ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: aC`,!'n&JLLC.�ti ft U�(,Z�Y11 !% CFJ7V1. CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.C#(REQUIRED): PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: tja S - !0 5-0S sift(oh co kth CONTACT EMAIL: O(C:mES)1)./104 @ymau tc0771 AGREEMENT:The undersigned applicant agrees to comply with all provisions of the Everett Municipal Code Title City of Everett Official Use Only 14 Water and Sewer or such other rules and regulations now existing or which maybe established from time to FEE time. The applicant further agrees,as a condition precedent to receiving service that the utilities division shall have �� 8'�. the right at any time,without notice,to shut off or tum on the water supply for repairs,construction,and J nonpayment of charges or for any other -.sonable cause.I am the owner,or I am authorized by the owner of this property to perf. e,�.1" for whic. ..�1ic. ;.n is made,and I comply with the State Contractors Law 18.27 PERMIT# RCW and 29%.200 7 2 a— / U M07-—037- Owne digliorized Agent S • ature Date f/d/ (Revised 10/12/2015)