1823 STATE ST 2021 Plans 2022-10-27 (2)

„ol WATER I SEWER UTILITY APPLICATION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-2:7-8810 ( FAX 425-257-8857 I(E)everetteps@everettwa.gov i www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 1823 State Street IF APPLICABLE: 0 OUTSIDE CITY LIMITS 0 BUILDING AREA SF 0 LOT# BUILDING TYPE: ✓D.SFR DTOWNHOUSE ODUPLEX DADU DMULTI FAMILY-#OF UNITS: DCOMMERCIAL ©ACCESSORY CHANGE OF USE? Q NO 0 YES, FROM TO UTILITY APPLICATION INFORMATION SEWER(check all that apply) WATER(check all that apply) ❑SIDE SEWER REPAIR 0 NEW WATER SERVICE INSTALLATION ❑SIDE SEWER ALTERATION 0 COMPLETE SERVICE 0 METER ONLY 0 NEW SIDE SEWER INSTALLATION SERVICE 1 METER USE: D INSTALL BACKWATER VALVE(outside the building) El SFR Existing Meter and Service ❑SIDE SEWER CAP-OFF 0 MULTI-FAMILY-#OF UNITS: ®SIDE SEWER RECONNECTION D COMMERCIAL MULTIPLE DOMESTIC WATER SERVICES REQUEST WATER SERVICE TYPE I SIZE:(provide calcs to support size choice) ❑I AM DECLINING MULTIPLE DOMESTIC WATER SERVICES FOR 0 DOMESTIC: 03/4” 01" 02" DOther: MY MULTI-FAMILY DEVELOPMENT UNDER SINGLE OWNERSHIP. 0 IRRIGATION: 03/4" 01" 02" DOther: ❑I AM OPTING TO INSTALL MULTIPLE DOMESTIC WATER 0 FIRE: 01" 02" 04" 06" 08" DOther: SERVICES FOR MY MULTI-FAMILY DEVELOPMENT UNDER 0 DOMESTIC/FIRE COMBO: 01" 02" DOther: SINGLE OWNERSHIP.FILL OUT REVERSE SIDE OF THIS FORM. 0 BACKFLOW PREVENTION(Outside): ❑RPBA ❑DCDA ❑DCVA CONTACT INFORMATION OWNER NAME: Tracy Sublett TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: meet 8429 14th Place SE cry Lake Stevens STATE WA ZIP 98258 OWNER PHONE: OWNER EMAIL:tracyhear2004@yahoo.com yahoo.com CONTRACTOR NAME:LEXAR Homes CONTRACTOR ADDRESS: STREET 3721 116th Street NE,Ste 9 crry Marysville STATE WA , 98271 CONTRACTOR PHONE:360.657.1968 CONTRACTOR EMAIL:TRhynes@lexarhomes.COm CONTRACTOR LIC.#(REQUIRED):LEXARH*850NC CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 61588 PRIMARY CONTACT: D OWNER 0 CONTRACTOR 0 OTHER(Please Specify) Agent CONTACT NAME: CONTACT PHONE:425.238.6324 Stacy Smith, SLDS CONTACT EMAIL:stacy©stacysmith.net AGREEMENT:The undersigned applicant agrees to comply with all provisions of the Everett Municipal Code Title 14 Water and Sewer or such other rules and regulations now existing or which may be established from time to time.The applicant further agrees,as a condition precedent to receiving service that the utilities division shall have the right at any time,without notice,to shut off or turn on the water supply for repairs,construction,and nonpayment of charges or for any other reasonable cause I am the owner,or I am authorized by the owner of this property to perfonn the work for which application is made,and I comply with the State Contractors Law 18.27 RCW and 298.200A WAC. City of Everett Official Use Only PERMIT# Stacy Smith s 03/2e.2{I21 „ 07bt12113529>.4735-RO Owner/Authorized Agent Signature Date (Revised 10/12/2018)