3217 COLBY AVE 2020-12-21 - Laserfiche WebLink

#,t11.11°1-- WATER / SEWER UTILITY APPLICATION Ak', 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 PROJECT SITE INFORMATION PROJECT ADDRESS: 21l Lb I le71. Ft"1-t o IF APPLICABLE: 0 OUTSIDE CITY LIMI S 0 BUILDING AREA SF 0 LOT# BUILDING TYPE: ❑SFR-DETACHED ❑SFR ATTACHED ❑DULEX ❑MULTI-FAMILY-#OF UNITS: ['COMMERCIAL ❑INDUSTRIAL CHANGE OF USE? %.1.4.2 ❑YES, FROM TO UTILITY APPLICATION INFORMATION SEWER(check all that apply) WATER(check all that apply) SIDE SEWER REPAIR 0 NEW WATER SERVICE INSTALLATION 0 SIDE SEWER ALTERATION ❑ COMPLETE SERVICE 0 METER ONLY • 0 NEW SIDE SEWER INSTALLATION SERVICE/METER USE: O INSTALL BACKWATER VALVE(outside the building) ❑ SFR ❑SIDE SEWER CAP-OFF 0 MULTI-FAMILY-#OF UNITS: El 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 0 DOMESTIC: 3/4", 1", 2", OTHER: MY MULTI-FAMILY DEVELOPMENT UNDER SINGLE OWNERSHIP. 0 IRRIGATION: 3/4", 1", 2", OTHER: 0 I AM OPTING TO INSTALL MULTIPLE DOMESTIC WATER 0 FIRE: 1", 2", 4", 6", 8", OTHER: SERVICES FOR MY MULTI-FAMILY DEVELOPMENT UNDER ❑ DOMESTIC/FIRE COMBO: 1", 2", OTHER: SINGLE OWNERSHIP. FILL OUT REVERSE SIDE OF THIS FORM. ��q ��p CONTACT INFORMATION OWNER NAME: I ,IIV WVi' ( V1 V l/7i ' ' 1L TENAN . //''��` y� TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET t(.(<1��LI� 1 , L & CITY Sit,�G��' "W STATE ZIPIg 1 I OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: ifilt P.tovito mil CONTRACTOR ADDRESS: STREET . 0co-it V'h ,y A ./ CITY STATE 1 A/A • ZIP �o CONTRACTOR PHONE:U4? At OI?�A CON TRACTOR EMAIL: �1 V Ay s )1rvr�� 4le, /1/141 O iNVIACONTRACTOR LIC.#(REQUIRED): �/� t Q CITY OF EVERETT BUSINs LIC.#(REQUIRED): o r_ PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: . CONTACT PHONE: �I� I lb I 121 1 1 �� CONTACT EMAIL: A / l) V9/IYI f ( 1s " ° 6®� `I ®C. AGREEMENT.:The undersigned applicant agrees to comply with all provisions of the Everett Municipal I ode Title City of Everitt Official.Use Only 14 Water and Sewer or such other rules and regulations now existing or which may be established from time to FEE time. The applicant further agrees, ._ "a con ''n precedent to receiving service that the utilities division shall have 0 the right at any ' e,w" t notic,to shut off o turn on the water supply for repairs,construction, and 3O O nonpayment ch,r.--s or`or an other reasona le cause.I am the owner,or I am authorized by the owner of this �/ property top- or he wo hich applicatio is made,and I comply with the State Contractors Law 18.27 PERMIT# 7vand 299 200 WAC 11. ii 2 Zp U W CD2-0 1/ ner/Authoriz-4;.gent Sig1ature Date (Revised 10/12/2015)