1525 FLORIDA DR 2022-04-15 - Laserfiche WebLink

W ER / SEWER UTILITY PLIC /11111j::4ATION it __ 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 SITEoiNFbRMATION PROJECT ADDRESS: / 5 5- //Q 66 JJ`� IF APPLICABLE: ❑OUTSIDE CITY LIMITS )<51.BUILDING AREA 5700 0 " SF Pi LOT# BUILDING TYPE: IijSFR-DETACHED ❑SFR-ATTACHED ❑DULEX ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL ❑INDUSTRIAL CHANGE OF USE? KCVO ❑YES, FROM TO r nS rt1 LIT£Y P;:gOA VN INFORM tilOf r '` h : ,i , SEWER(check all that apply) WATER(check all that apply) ❑SIDE SEWER REPAIR : NEW WATER SERVICE INSTALLATION ❑SIDE SEWER ALTERATION 0 COMPLETE SERVICE 121.METER ONLY ANEW SIDE SEWER INSTALLATION SERVICE/METER USE: ❑INSTALL BACKWATER VALVE(outside the building) ❑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: 3/4", 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 SiDOMESTIClFIRE COMBO: 1", 2", OTHER: SINGLE OWNERSHIP.FILL OUT REVERSE SIDE OF THIS FORM. ,: ...-,-,..::"14:.:',1,. z... . CONTACT=INFORMATION ; OWNER NAME: 1 L5r/it COS-reel 6:04,() ct(WENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET 0, ar),f 42 Li 47(y c)zLJ CITY c�,- STATE 70 ZIP OWNER PHONE: y.r-6 76•-6 c-5` OWNER EMAIL: AU.SrAktCiJ.STr7,Ite-oi(i_srf �Iv!'I%tub a �/1/L CONTRACTOR NAME: c Oj/41-rA\C(-)c ro /1 (3/U."7''Zl�g76A/ CONTRACTOR� � ADDRESS:) �S STREET �7 r O -/& . / / �' '� �///�yS !r^�LJ C CITY C'C. I� STATE ?9 2 70 ZIP CONTRACTOR PHONE: '/ P-97& 6 IS"/ CONTRACTOR EMAIL:Eu /l (t)SJ`GrpZ co/v..),2v 776,(10-6/4/rj..... CONTRACTOR LIC.#(REQUIRED):,, (2-Cr�C 7,72 16 C. CITY OF EVERETT BUSINESS LIC #(REQUIRED) 5333.�, PRIMARY CONTACT: 29-OWNER a:CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: L[ . 9 76- r oandA easnik CONTACT EMAIL: !, ... -:,:. 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 may be established from time to FEE 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.I am the owner,or 1 am authorized by the owner of this property to perform the work for which application is made,and I comply with the State Contractors Law 18.27 PERMIT RCWa 96.200A WAC ti L,q1:2fr:r)‹ Owner/Authorized Agent Sign ure Date /q a (Revised 10/12/2015)