2102 HOYT AVE 2022-03-01 - Laserfiche WebLink

WATER I SEWER UTIUTT APPUCAMN wili 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 SETE MVO .'IV ATIIO I PROJECT ADDRESS: 2,1t2, V .)It"APPLI CABLE: ❑OUTSIDEIMITS 0 BUILDING AREA SF ❑ LOT# BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑DULEX ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL ❑INDUSTRIAL CHANGE OF USE? NO ❑YES, FROM TO �TELI)TY APPLECATIJOM EC FO MATEGE1 SEWER (check all that apply) WATER(check all that apply) 0 SIDE SEWER REPAIR D NEW WATER SERVICE INSTALLATION ❑SIDE SEWER ALTERATION 0 COMPLETE SERVICE ❑ METER ONLY ❑ NEW SIDE SEWER INSTALLATION SERVICE/METER USE: 0 INSTALL BACKWATER VALVE(outside the building) 0 SFR ❑ SIDE SEWER CAP-OFF 0 MULTI-FAMILY-#OF UNITS: ❑ SIDE SEWER RECONNECTION ❑COMMERCIAL MULTIPLE DOMESTIC WATER SERVICES REQUEST WATER SERVICE TYPE/SIZE: (circle desired size) O I AM DECLINING MULTIPLE DOMESTIC WATER SERVICES FOR 0 DOMESTIC: 3/4", 1", 2", OTHER: MY MULTI-FAMILY DEVELOPMENT UNDER SINGLE OWNERSHIP. ❑ IRRIGATION: 3/4", 1", 2", OTHER: ❑ I AM OPTING TO INSTALL MULTIPLE DOMESTIC WATER 0 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. CONT If CT EVHFOR ATEO 1 OWNER NAME: / {)/, (i1 l TENANT NAME (If Commercial): OWNER MAILING ADDRESS: 1 STREET CITY STATE. ZIP OWNER PHONE: ,( OWNER EMAIL: VJ CONTRACTOR NAME: / 1 P, k ,CONTRACTOR ADDRESS: STREET \irV CITY �j STATE W6t c ZIP g��0(L�f'> CONTRACTOR PHONE: !2 1 ®V�A� CO TRACTOR EMAIL: ,O\ta/t J1f l/ l , 6 Oiji �� 1 _i/1 LIC.#(REQUIRED): I A4 ,�4 , Nit CITY OF EVERETT BUSIN LIC.#(REQUIRED): ® j 4 CONTRACTOR ( _.., '!.,,4..� +1 _-...#! .. PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: , CONTACT PHONE: LI-1°1 tI 4A'1 61 21 a ,iyJ % ci\ U lL CONTACT EMAIL: 4 a'vIl 111 Maio i [ ,C i AGREEMENT:The undersigned applicant agrees to comply with all provisions of the Everett Municipal Code Title `,..) City of Ever t Official Use Only 14 Water and Sewer or such other rules and regulations now existing or which may be established from time to F E E time.The applicant further agrees, . a con•r precedent to receiving service that the utilities division shall have (� the right at any ' e,IV . t notic to shut off o turn on the water supply for repairs,construction,and 9n nonpayment• ch- a-s or or an,other reasona 4 le cause.I am the owner,or I am authorized by the owner of this property top- or he wo 4 hich applicatio is made,and I comply with the State Contractors Law 18,27 PERMIT O RCW and 29;200 WAC , U I h� Owner/Authoriz•t•gent Sig,ature Date (Revised 10/12/2015)