3004 93RD PL SE 2022-05-23 - Laserfiche WebLink

WATER /SEWER UTILITY APPLICATION EVERETT WASHINGTON CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITEi INFORMATION PROJECT ADDRESS: 3004 93rd Place SE Everett 98208 IF APPLICABLE: ❑✓ OUTSIDE CITY LIMITS ❑ BUILDING AREA SF ❑ LOT # 7 BUILDING TYPE: ❑✓SFR ❑TOWNHOUSE ❑DUPLEX ❑ADU ❑MULTI -FAMILY-# OF UNITS: ❑COMMERCIAL ❑ACCESSORY CHANGE OF USE? 0 NO ❑ YES, FROM TO SEWER (check all that apply) I WATER (check all that apply) ❑ SIDE SEWER REPAIR ❑ SIDE SEWER ALTERATION ❑✓ NEW SIDE SEWER INSTALLATION ❑ INSTALL BACKWATER VALVE (outside the building) ❑ SIDE SEWER CAP -OFF ❑ SIDE SEWER RECONNECTION MULTIPLE DOMESTIC WATER SERVICES REQUEST ❑✓ I AM DECLINING MULTIPLE DOMESTIC WATER SERVICES FOR MY MULTI -FAMILY DEVELOPMENT UNDER SINGLE OWNERSHIP ❑ I AM OPTING TO INSTALL MULTIPLE DOMESTIC WATER SERVICES FOR MY MULTI -FAMILY DEVELOPMENT UNDER SINGLE OWNERSHIP. FILL OUT REVERSE SIDE OF THIS FORM. 0 NEW WATER SERVICE INSTALLATION ❑ COMPLETE SERVICE 9 METER ONLY SERVICE / METER USE: ❑✓ SFR ❑ MULTI -FAMILY - # OF UNITS: ❑ COMMERCIAL WATER SERVICE TYPE / SIZE: (provide calcs to support size choice) ❑ DOMESTIC: R3/4 ❑111 ❑2" ❑Other : ❑ IRRIGATION: 113/411 El 112" ❑Other : ❑ FIRE: ❑111 ❑2" ❑4" ❑6" ❑8" []Other: ❑ DOMESTIC/FIRE COMBO: ❑1" ❑2" ❑Other : ❑ BACKFLOW PREVENTION (Outside): ❑RPBA ❑DCDA ❑DCVA CONTACT INFORMATION OWNER NAME: Harbour Homes LLC TENANT BUSINESS NAME (If Commercial): OWNER MAILING ADDRESS: STREET400 North 34th Street CITY Seattle STATE WA Z,p 98103 OWNER PHONE: (206) 315-8130 OWNER EMAIL: AWIrtZ@harbourhomeS.Com CONTRACTOR NAME: Team Northwest Excavating CONTRACTOR ADDRESS: sTREET 13930 State Route 9 NE c,n Arlington STATE WA Z,p 98223-4973 CONTRACTOR PHONE: (425) 7554-6500 CONTRACTOR EMAIL: CONTRACTOR LIC. #(REQUIRED): 6032664210010001 CITY OF EVERETT BUSINESS LIC. #(REQUIRED): 61239 PRIMARY CONTACT: ❑✓ OWNER ❑ CONTRACTOR ❑ OTHER (Please Specify) CONTACT NAME: Austin Wirtz CONTACT PHONE: (4255) 361-5797 CONTACT EMAIL: AWlrtz@harbourhomeS.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. I 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 RCW and 296.200A WAC. City of Everett Official Use Only PERMIT # Austin Wirtz M oe 9r144A9:25 T00 t@"amour"amescam 8/19/19 U 9 ?I® -0450 Owner/Authorized Agent Signature Date (Revised 1011212018)