2214 8TH ST 2022-05-18 - Laserfiche WebLink

elp.44%,...:1, ______ , ,,ATER I SEWER UT DUTY APPUUCATI N 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: 11•02•41 'etslv cct. l gV` rekt A . IF APPLICABLE: ❑ OUTSIDE CIT NITS ❑ BUILDING AREA SF 0 LOT# BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑DULEX ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL ❑INDUSTRIAL CHANGE OF USE? 1\12 ❑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: Ik INSTALL BACKWATER VALVE(outside the building) ❑ SFR ❑ SIDE SEWER CAP-OFF ❑ MULTI-FAMILY-#OF UNITS: ❑ SIDE SEWER RECONNECTION ❑ COMMERCIAL MULTIPLE DOMESTIC WATER SERVICES REQUEST WATER SERVICE TYPE/SIZE: (circle desired size) ❑ I AM DECLINING MULTIPLE DOMESTIC WATER SERVICES FOR ❑ 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 ❑ 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: '11M,All d• 1 t i-QJ TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET 221 �`VA t� 1 • CITY mi STATE r ZIP� '2b1 OWNER PHONE: OWNER EMAIL: vVY�' CONTRACTOR NAME: Alt P, k • CONTRACTOR ADDRESS: STREET G 1 v 1� , ,V 9 CITY eAttreil 1 STATE WA, • / wZZIIP C,13206 CONTRACTOR PHONE:U42 )At®12� CONTRACTOR EMAIL: �1 bl l IC, 241 tj 160114 l CONTRACTOR LIC.#(REQUIRED): * I 1, QD CITY OF EVERETT BUSIN LIC.#(REQUIRED): ® 155(4, PRIMARY CONTACT: ❑OWNER ❑ CONTRACTOR ❑ OTHER(Please Specify) CONTACT NAME: /�j� CONTACT PHONE: LI� k)'�r1.L CI��21 ��/��a CI1 I;,., ; CONTACT EMAIL: A I lAthiiI ' 1 ,C 2410 4i'i'I AI *CNA AGREEMENT:The undersigned applicant agrees to comply with all provisions of the Everett Municipal diode 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 IA time. The applicant further agrees,as a condition precedent to receiving service that the utilities division shall have the right at anytime,without notice,to shut off or,,turn on the water supply for repairs,construction,andlit nonpayment of charges or'"or 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 PERMIT# RCW and 29d:200A WAC U W OZ— O^ G .)( caner/Authorized Agent Signature Date (Revised 10/12/2015)