5113 SOUND AVE 2022-05-10 - Laserfiche WebLink

Aug 30 19,00:55 Holstad's PLUMBING INC, 3605889814 p.1 ‘.,";1., TER I SEWER UTQLOTAPPUCAT.' ^� a CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT WA 98201 (P)425-257-8810 J FAX 425-257-8857 f (E) everetteps@everettwa.gov p @everetiwa.gov I u:Mnmevereffiwa.gov/permits PROJECT..'sift 1NFORP ATffON PROJECT ADDRESS: t1." .0 U ikG 69 6 e. e v I g .3 c: 03 IF APPLICABLE: ❑OUTSIDE CITY LIMITS ❑SF BUILDING AREA SF El LOT# BUILDING TYPE: OSFR-DETACHED R-ATTACHED ❑DULEX OMULTI-FAMILY-#OF UNITS: ❑COMMERCIAL QINDUSTRIAI CHANGE OF USE? 21140 I]YES, FROM TO UTILITY AFiTL,ICATNON NNFORMA'if`Il®1Nf SEWER(check all that apply) WATER(check all that apply) El SIDE SEWER REPAIREW WATER SERVICE INSTALLATION El SIDE SEWER ALTERATION 0 COMPLETE SERVICE 0 METER ONLY El NEW SIDE SEWER INSTALLATION SERVICE 1 METER USE: El INSTALL BACKWATER VALVE(outside the building) ❑SFR ❑ SIDE SEWER CAP-OFF ❑MULTI-FAMILY-4 OF UNITS: ❑SIDE SEWER RECONNECTION CI COMMERCIAL • MULTIPLE DOMESTIC WATER SERVICES REQUEST WATER SERVICE TYPE 1 SIZE: (circle desired size) Ell AM DECLINING MULTIPLE DOMESTIC WATER SERVICES FOR El DOMES71C: MY Iv1ULTl-F4MILYDE1lELOPMENTUNDER SINGLE OWNERSHIP. 3/4 1", 2", OTHER: f f IRRIGATION: 47/ 3/4", '', 2", OTHER: ❑ I AM OPTING TO INSTALL MULTIPLE DOMESTIC WATER Cf FIRE: 1", 2", 4", 6", 8", OTHER: SERVICES FOR MY MULTI-FAMILY DEVELOPMENT UNDER SINGLE OWNERSHIP.FILL OUT REVERSE SIDE OF THIS FORM. 0 DOMESTIC/FIRE COMBO: 1", 2+', OTHER: J . CONTACTNFORMA`t10N . . OWNER • • NAME: I�h !� Y' t Uf- ��^ G ~. ..;....... .:.... ...... . . . . .. . .. .. .. .- �► 1 t o 5e 1/) TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STFtEEr crrt STATE OWNER PHONE: i "�/ �f* l !_ZIP 7 1� � ! !OWNER EMAIL: �r.G(r.:Vet 1 ' IA ...P"4 t 1n?I C,7 0 on CONTRACTOR NAME.: Ho` ! g P I be W CONTRACTOR ADDRESS: srREET P-3 /jt x, 6 /_(CJ 5 CfrY 5. Y A, STATE iej41X, ZIP 9 a N CONTRACTOR PHONE: q 0?y ,,?5 ? Q/ W [CONTRACTOR EMAIL: CONTRACTOR LIC.#{F2=CIUI�ED): a IGlri tJ(��O�ry 'CITY OF EVERETT BUSINESS LIC. #(REQUIRED PRIMARY CONTACT: El OWNER ,I2rCONTRACTOR CI OTHER(Please Specify) i-sOa��{{�a(� R Specify) CONTACT NAME: CONTACT PHONE: 4/a 5- cy a J 42 1 e rItq CONTACT EMAIL: AGREEvlENT.The undersigns pticantagrees to comply with all provisions of the vereit Municipal Code Title 14 Waterand Sewer or such other rules and regulations now existing or which may be established from time to City of Everett Official Use Only lime.The applicant further agrees,as a condition precedent to receivin r FEE g se rvica that the uiilities division steal!have ( r AA the right at anytime,without notice,to shut off or turn on the water supply for repairs,construction,and tit 2- _S , O/ `nonpayment of charges or far an other reasonable cause.I am the owner,or 1 ams authorized by the owner of this \\\ �O v property to form the worir far Job application is made,and i comply with the State Ccntraciors Law 19,27 RC • 7d29 2oDA I�JA PERMIT L; r‘fri-itlikk" • U efl CO Owner/Authorized Agent Signet Date (Revised 10/1212015)