120 W CASINO RD BLDG 39 PARK 120 APTS 2023-01-23

WATER / SEWER UTILITY APPLICATION +0 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 � . .., . . r,? s 24--,', _: , V *nay. ., �s �:� � i. , wk�, Ft,- �� PROJECT ADDRESS / 0 ZA c ,C 5ii � 1.1 } " 'I 1F APPLICABLE: 0 OUTSIDE CITY_LIMITS_ .0 BUILDING AREA SF (]..LOT it 'BUILDING TYPE: ❑SFR ❑TOWNHOUSE ❑DUPLEX ❑ADU LMULTL-FAMILY-#OF UNITS: ❑COMMERCIAL ❑ACCESSORY CHANGE OF USE? ❑NO ❑YES, FROM TO SEWER(check all that aper WATER(check all that apply) SIDE SEWER REPAIR ❑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: 0 SIDE SEWER RECONNECTION ❑COMMERCIAL MULTIPLE DOMESTIC WATER SERVICES REQUEST WATER SERVICE TYPE/SIZE:(provide calcs to support size choice) ❑I AM DECLINING MULTIPLE DOMESTIC WATER SERVICES FOR ❑DOMESTIC: 03/4" 01" 02" ❑Other: MY MULTI-FAMILY DEVELOPMENT UNDER SINGLE OWNERSHIP.. LI IRRIGATION: ❑3/4" 01" 02" ❑Other: ❑I AM OPTING TO INSTALL MULTIPLE DOMESTIC WATER ❑FIRE: 01" 002" 04" 06" 08" ❑Other: SERVICES FOR MY MULTI-FAMILY DEVELOPMENT UNDER ❑DOMESTIC/FIRE COMBO: 01" 02" ❑Other: SINGLE OWNERSHIP. FILL OUT REVERSE SIDE OF THIS FORM. CI BACKFLOW PREVENTION(Outside): ❑RPBA COCOA LDCVA k V OWNER NAME: Pa,,_ \2., TENANT BUSINESS NAME(If Commercial)., OWNER MAILING ADDRESS: STREET 120 $A Q si' ('_ t nom^ F cm' UPx't? '' STATE Iil� pk ZIP Cit$2,0_Li OWNER PHONE,44G. 31 to 9q2"1 OWNER EMAIL: CONTRACTOR NAME.8cylstatzt TOR ADDRESS STREET 2660 S � ,S± CITY ,;..,._, STATE ZIP Ri. 41E1� CONTRACTOR PHONE._., t�, 9 5 t :G29 f- 7 [CONTRACTOR EMAIL; char j oci( r-cp (yry"i CONTRACTOR LIC #(REQUIRED): d a e oe4t0.22 CITY OF EVERETT BUSINESS LIC.#(REQUIRED: = r,' 14_ PRIMARY CONTACT ❑OWNER CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE 2,0 tP tj�"i 2q 17 ChQ,kiene LAA,,,X . ref) CONTACT EMAIL � + t e ' t )�� Cr ' AGREEMENT:The undersigned applicant,p 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 shell 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 Slate Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use OnI' PERMIT t l °fl;cid Agent Date (Revised 10/12/2018)