3007 PANAVIEW BLVD 2022-11-18 - Laserfiche WebLink

WtER / SEWER UTILITY A'LICATION `i CITY OF EVERETT PERMIT SERVICES EVERETT SUBMITTAL INSTRUCTIONS:Drop off hard copy paper application&plans to 3200 Cedar Street 2nd Floor Intake Drop Box. WASHINGTON CONTACT INFORMATION:(P)425.257.8810 I(E)PermitServices@everettwa.gov I(W)everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 3 co-7 --PA 0.1 AEI 1 E.-.r-i 3L—J IF APPLICABLE: 0 OUTSIDE CITY LIMITS ❑ BUILDING AREA SF ❑LOT# BUILDING TYPE: $SFR ❑TOWNHOUSE ❑DUPLEX ❑ADU ❑MULTI-FAMILY #OF UNITS: ❑COMMERCIAL ❑ACCESSORY CHANGE OF USE? *NO ❑YES, FROM TO UTILITY APPLICATION INFORMATION SEWER(check all that apply) WATER(check all that apply) ❑SIDE SEWER REPAIR ABACKFLOW PREVENTION(Outside)-Specify device type below: ❑SIDE SEWER ALTERATION ❑RPBA(dom.) ❑DCVA(dom.) IDCVA(irr.) ❑DCDA(fire) ❑NEW SIDE SEWER INSTALLATION Itif WATER LINE BEHIND METER(repair or alteration) ❑ INSTALL BACKWATER VALVE(outside the building) 0 NEW WATER SERVICE INSTALLATION ❑SIDE SEWER CAP-OFF Specify installation type below: ❑SIDE SEWER RECONNECTION 0 NEW COMPLETE SERVICE MULTIPLE DOMESTIC WATER SERVICES REQUEST 0 METER ONLY ❑I AM DECLINING MULTIPLE DOMESTIC WATER SERVICES FOR Specify water service type&size below: MY MULTI-FAMILY DEVELOPMENT UNDER SINGLE OWNERSHIP. 0 DOMESTIC: 03/4" 01" 02" ❑Other: ❑ I AM OPTING TO INSTALL MULTIPLE DOMESTIC WATER IRRIGATION: 13/4" 01" 02" ❑Other: SERVICES FOR MY MULTI-FAMILY DEVELOPMENT UNDER 0 FIRE: 01" 02" 04" 06" 08" ❑Other: SINGLE OWNERSHIP.FILL OUT REVERSE SIDE OF THIS FORM. 0 DOMESTIC/FIRE COMBO: 01" 02" ❑Other: CONTACT INFORMATION OWNER NAME: Eva aZIv TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET as t..) s LI 16'2hct Ave , 14S" CITY M t a m lay F L ZIP 3 3(.33 OWNER PHONE:(30 ) 302 - 68 re OWNER EMAIL: E E. la y z 14o V yak0O. eo WI CONTRACTOR NAME: CONTRACTOR ADDRESS: STREET CRY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): .� PRIMARY CONTACT: Lf OWNER 0 CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: (_ V v e 9 Ry-a ktl✓ CONTACT PHONE: C3 0 5) 302 — 68 ,7Z v CONTACT EMAIL: E• lye kOv(J yahoo , cow AGREEMENT:The undersigned applicant agrees to comply with all provisions of the Everett Municipal Code Titlet 14 Water and Sewer or such other rules and regulations now existing. - •ich 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 tis e,with. t notice,t. 1 ut 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 1 am aut.:rized byte owner,'- his property to perform the work for which application is made,and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only % PERMIT# ' - �2 z 0,22 e U 2202 032- /. ��m' _ • led Agent Signature ate (Revised 8/4/2021) ,i'I