7909 EVERGREEN WAY MOD PIZZA 2021-01-28

• ATER / SEWER UTILITY APPLICATION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 7909 Evergreen Way (MOD PIZZA) IF APPLICABLE: ❑OUTSIDE CITY LIMITS ❑ BUILDING AREA SF ❑LOT# BUILDING TYPE: ❑SFR ❑TOWNHOUSE EDUPLEX ❑ADU ❑MULTI-FAMILY-#OF UNITS: ❑✓COMMERCIAL ❑ACCESSORY. CHANGE OF USE? OO NO ❑YES, FROM TO UTILITY APPLICATION INFORMATION SEWER (check all that apply) WATER(check all that apply) PP Y) SIDE SEWER REPAIR it NEW WATER SERVICE INSTALLATION ❑SIDE SEWER ALTERATION ❑COMPLETE SERVICE ❑METER ONLY ❑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) 7 I AM DECLINING MULTIPLE DOMESTIC WATER SERVICES FOR ❑DOMESTIC: 1113/4" ❑l" 02" . Other: MY MULTI-FAMILY DEVELOPMENT UNDER SINGLE OWNERSHIP. ❑IRRIGATION: 03/4" 01" 02" ❑Other: ❑I AM OPTING TO INSTALL MULTIPLE DOMESTIC WATER SERVICES FOR MY MULTI-FAMILY DEVELOPMENT UNDER ❑FIRE: ❑1" ❑2" ❑4" ❑6" ❑8" ❑Other SINGLE OWNERSHIP. FILL OUT REVERSE SIDE OF THIS FORM. ❑✓ BACKFLOW PREVENTION (Outside): ❑RPBA ❑✓DCDA ❑DCVA CONTACT INFORMATION OWNER NAME: Evergreen Burg LLC TENANT BUSINESS NAME(If Commercial): MOD Pizza OWNER MAILING ADDRESS: sTREET615 NW 162d St CITY Shoreline STATE WA Zip 98290 OWNER PHONE:206-779-0177 'OWNER EMAIL:evergreenburg@msn.com 9 g@msn.com CONTRACTOR NAME:GregCO Excavation LLC CONTRACTOR ADDRESS: STREET PO Box 129 CITY Lake Stevens STATE WA ZIP 98258 CONTRACTOR PHONE:425-220-8289 CONTRACTOR EMAIL: CO LEE i A C6 l C "Gf @ Lo� _ CONTRACTOR LIC.#(REQUIRED): FZ � -�� Llr � �^� J ICITY OF EVERETT BUSINESS LIC.#(REQUIRED): 5 3 5 PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑✓ OTHER(Please Specify) Corstone Contractors,General Contractor CONTACT NAME: CONTACT PHONE: 425-248-0134 Rob Marchand CONTACT EMAIL:rob©corstonellc.com 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.t am the owner,or I 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 ROW and 296.200A VVAC. City of Everett Official Use Only PERMIT# January 30, 2019 U Owner/Authori= d A I gent Signature Date — O (Revised 10/12/2018)