702 47TH ST SE 2022-03-02 - Laserfiche WebLink

WATER I SEWER UI1UI T Y i PPUUCAI]O 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 INFO! ' MATIO', PROJECT ADDRESS: 1 Q2 i'n.' .S , SEJ IIF APPLICABLE: ❑ OUTSIDE CITY LIMITS ❑ BUILDING AREA SF ❑ LOT# 'BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑DULEX ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL ❑INDUSTRIAL CHANGE OF USE? 10 NO ❑YES, FROM TO UTILITY APPLICATI=11)N INFORMATION SEWER (check all that apply) WATER(check all that apply) ti(SIDE SEWER REPAIR ❑ 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) ❑ 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: LA t)\(4 k m `V r u ` � e_ � Ou Y, k�il'1> TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET 1n T. \-'n '161gT, s CITY / �JL STATE VOA. ZIP `///�' %r2-0,3 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: A*P Q .atIlj CONTRACTOR ADDRESS: STREETA Vlbfit , . •ze,1 CITY STATE EA/A, a ZIP �,00 CONTRACTOR PHONE: )At ®12 CO TRACTOR EMAIL:& ,I Uvt(_YYr!!"" 1,le, 1Ln 09 1 ielIM CONTRACTOR LIC.#(REQUIRED): l4 1, U t j CITY OF EVERETT BUSIN LIC.#(REQUIRED): 51a PRIMARY CONTACT: ❑OWNER ❑ CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: L I Z'o q I G �1,1WI\,---- CONTACT EMAIL: T ] C zLr10 a / AGREEMENT.The undersigned applicant agrees to comply with all provisions of the Everett Municipal ode Title `� 6 City offf 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 FEE it time. The applicant further agrees, a conditign precedent to receiving service that the utilities division shall have (J the right at any . e,wilhRut notic , to shut off o turn on the water supply for repairs,construction, and4fie770.0._ nonpayment ch r es or or any other reasona le cause.I am the owner, or I am authorized by the owner of this property top or he wo hich applicatio is made,and I comply with the State Contractors Law 18.27 PERMIT# RCW and 296i 200 WAC '' d -- 5 1c1 U ta101 "0 wner/Authoriz gent Sig ature Date (Revised 10/12/2015)