2518 MONROE AVE 2022-01-25 - Laserfiche WebLink

4rEir WATER / SEWER UTILITY APPLICATION 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 SITE INFORMATION PROJECT ADDRESS: ;. IF APPLICABLE: El OUTSIDE CITY LIMITS ❑ BUILDING AREA SF ❑ LOT# BUILDING TYPE: ❑SFR-DETACHED DSFR-ATTACHED ❑DULEX ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL DI INDUSTRIAL CHANGE OF USE? El NO ❑YES, FROM TO UTILITY APPLICATION INFORMATION SEWER(check all that apply) 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) 0 SFR ❑ SIDE SEWER CAP-OFF ❑ MULTI-FAMILY-#OF UNITS: ❑ SIDE SEWER RECONNECTION El COMMERCIAL MULTIPLE DOMESTIC WATER SERVICES REQUEST WATER SERVICE TYPE/SIZE: (circle desired size) ❑ I AM DECLINING MULTIPLE DOMESTIC WATER SERVICES FOR 0 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 ❑FIRE: 1", 2", 4", 6", 8", OTHER: SERVICES FOR MY MULTI-FAMILY DEVELOPMENT UNDER ❑ DOMESTIC/FIRE COMBO: 1", 2", OTHER: SINGLE OWNERSHIP. FILL OUT REVERSE SIDE OF THIS FORM. CONTACT INFORMATION OWNER NAME: ` C� �� (j c;I^u TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET 57' ,--le CITY STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: ;( +7 J26 ,tic CONTRACTOR ADDRESS: STREET CITY ��C;tr t- STATE 1 44 ZIP 9e/-4' CONTRACTOR PHONE: CONTRACTOR EMAIL: �/ CONTRACTOR LIC.#(REQUIRED): (<c;I ' C t f j CITY OF EVERETT BUSINESS LIC.#(REQUIRED): C 3 7 7 Z PRIMARY CONTACT: ❑ OWNER „rYCONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: i:f ? ) j-f(c CSC:.=J 1\l-t L) CONTACT EMAIL: c 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 r 1 �/� 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 LA/ 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 PER IT RCW and 296.200A WAC. j:// /,',/ U \ bD Owner/Authorized Agent Signature DV'e (Revised 10/12/2015)