11014 19TH AVE SE BIMS LAUNDRY CAFE 2021-02-26

VACER / SEWER UTILITY /LIGATION CITY OF EVERETT PERMIT SERVICES EVERETT 3200 CEDAR STREET, EVERETT, WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I (E) everetteps@everettwa.gov I https://everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: /��y /aL`t ` IF APPLICABLE: 0 OUTSIDE CITY LIMITS ❑ BUILDING AREA SF 0 LOT# BUILDING TYPE: ❑SFR ❑TOWNHOUSE ❑DUPLEX ❑ADU ❑MULTI-FAMILY-#OF UNITS: I 'COMMERCIAL ❑ACCESSORY // CHANGE OF USE? ❑NO 0 YES, FROM 13u l lca 14/)c TO MAL1 Af p,l ic. P� UTILITY APPLICATION INFORMATION SEWER (check all that apply) WATER(check all that apply) ❑SIDE SEWER REPAIR 0 NEW WATER SERVICE INSTALLATION IX SIDE SEWER ALTERATION 0 COMPLETE SERVICE 0 METER ONLY ❑ NEW SIDE SEWER INSTALLATION SERVICE/METER USE: ❑ INSTALL BACKWATER VALVE(outside the building) 0 SFR ❑ SIDE SEWER CAP-OFF 0 MULTI-FAMILY-#OF UNITS: ❑ SIDE SEWER RECONNECTION 0 COMMERCIAL MULTIPLE DOMESTIC WATER SERVICES REQUEST WATER SERVICE TYPE/SIZE: (provide calcs to support size choice) O I AM DECLINING MULTIPLE DOMESTIC WATER SERVICES FOR 0 DOMESTIC: ❑3/4" 01" 02" ❑Other: MY MULTI-FAMILY DEVELOPMENT UNDER SINGLE OWNERSHIP. ❑ IRRIGATION: 03/4" 01" 02" ❑Other O I AM OPTING TO INSTALL MULTIPLE DOMESTIC WATER 0 FIRE: 01" 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. 0 BACKFLOW PREVENTION (Outside): ❑RPBA ❑DCDA ❑DCVA CONTACT INFORMATION OWNER NAME: Iv / TENANT BUSINESS NAME(If Commercial): DAV it) ¶ ),%SA OWNER MAILING ADDRESS: STREETf-/frjy /�)n 5 CITY C—At e1 . \� STATE C.A+(.L• ZIP 96 O/Z OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: £ i it CONTRACTOR ADDRESS: STREET J q'�_�2_ /41 t/ ter}/ �J CITY lam//). 06 /j STATE eat, ZIP / M!/ 3 e CONTRACTOR PHONE:'2bI 6 y 1 /9T ? (CONTRACTOR EMAIL: COI itrick L a arr. .C CONTRACTOR LIC.#(REQUIRED): DOG- GC1 36 3 j CITY OF EVERETT BUSINESS LIC.#(REQUIRED): c7 6 S PRIMARY CONTACT: 0 OWNER aCONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: I CONTACT PHONE: `206 ( 31 ,._pt CONTACT EMAIL: c 1.1 � �y ;,fit 1. ex, � J AGREEMENT:The undersigned applicant agrees to comply with all provisions of the Everett Municipal Code Title 14 Water an 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, 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 I am authorized by the own f this property to perform the work for which application is made,and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only PERMIT# Di/V/ 2° U (2-CC CZ Owne orize gent Signa ure Dat (Revised 4/15/2019)