619 48TH ST SE 2022-03-02 - Laserfiche WebLink

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: (D\. I uk l! Cr.J l2 IF APPLICABLE: 0 OUTSIDE CITY LIMITS ❑ BUILDING AREA SF ❑ LOT# BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ODULEX ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL DINDUSTRIAL CHANGE OF USE? 'NO ❑YES, FROM TO UTILITY APPLICATION INFORMATION SEWER(check all that apply) WATER(check all that apply) Igj SIDE SEWER REPAIR ❑ NEW WATER SERVICE INSTALLATION El SIDE SEWER ALTERATION 0 COMPLETE SERVICE 0 METER ONLY ❑ NEW SIDE SEWER INSTALLATION SERVICE/METER USE: 0 INSTALL BACKWATER VALVE(outside the building) 0 SFR ❑ SIDE SEWER CAP-OFF El MULTI-FAMILY-#OF UNITS: ❑ SIDE SEWER RECONNECTION 0 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 0 FIRE: 1", 2", 4", 6", 8", OTHER: SERVICES FOR MY MULTI-FAMILY DEVELOPMENT UNDER 0 DOMESTIC/FIRE COMBO: 1", 2", OTHER: SINGLE OWNERSHIP. FILL OUT REVERSE SIDE OF THIS FORM. CONTACT INFORMATION OWNER NAME: �\r r l K\A,{O Vi IPV TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET W Cr. v/�� Q hn CITY /_J STATE V� ZIP ` O7,0;/ OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: V J Pr Q[Wm I) CONTRACTOR ADDRESS: STREET 1 VP etG�, / . CITY STATE WA, • ZIP qSatiora CONTRACTOR PHONE:l 4'Th ) 40 012 ) CO TRACTOR EMAIL:u,pA bl 1 IC �i O ON14 l CONTRACTOR LIC.#(REQUIRED): )lA CITY OF EVERETT BUSIN LIC.#(REQUIRED): O PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: • CONTACT PHONE: L,1-11J 1 Lb 1 g/Zi f/^n ,r 6 1w4\ YA-11 CONTACT EMAIL: Al I 11 i �C `� 1 ' �VO ll tom r AGREEMENT The undersigned applicant agrees to comply with all provisions of the Everett Municipde Title City of Evet Official Use Only r 14 Water and Sewer or such other rules and regulations now existing or which may be established from time to FEE time. The applicant further agrees, . a con.i'•n precedent to receiving service that the utilities division shall have the right at any ' e,w' • t notic',to shut off o turn on the water supply for repairs,construction,and -60'c-( ' nonpayment• ch-r.-s or or an other reasona.le cause.I am the owner, or l 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 29:200 A WAC C b. 0 n I caner/Authoriz �'� gent Sig,ature Date (Revised 10/12/2015)