518 E BEECH ST 2025-03-03 - Laserfiche WebLink

mil WATER / SEWER UTILITY APPLICATION 1 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 l(E)PermitServices@everettwa.gov I(W)everettwa. v/permits JJ PROJECT SITE INFORMATION / PROJECT ADDRESS: 'J i '6 ge€G 41 5-1-, f-vra'-eta U},4 95 IF APPLICABLE: 0 OUTSIDE CITY LIMITS 0 BUILDING AREA SF 0 LOT# BUILDING TYPE: IIQSFR ❑TOWNHOUSE ❑DUPLEX ❑ADU ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL ❑ACCESSORY CHANGE OF USE? �NO 0 YES, FROM TO ,47 UTILITY APPLICATION INFORMATION SEWER(check all that apply) WATER (check all that apply) ❑SIDE SEWER REPAIR 0 BACKFLOW PREVENTION(Outside)-Specify device type below: ❑SIDESI SEWER ALTERATION ❑RPBA,(dom.) ❑DCVA(dom.) ❑DCVA(irr.) ❑DCDA(fire) Ud NEW SIDE SEWER INSTALLATION _ 0 WATER'LINE BEHIND METER(repair or alteration) O INSTALL BACKWATER VALVE(outside the building) S 2(NEW WATER SERVICE INSTALLATION ❑SIDE SEWER CAP-OFF Specify installation type below: ❑SIDE SEWER RECONNECTION 0<JEW COMPLETE SERVICE MULTIPLE DOMESTIC WATER SERVICES REQUEST 0 METER ONLY ❑ I AM DECLINING MULTIPLE DOMESTIC WATER SERVICES FOR Specify/ water service typee&&size below: MY MULTI-FAMILY DEVELOPMENT UNDER SINGLE OWNERSHIP. L�DOMESTIC: Ei3/4" 01" 02" ❑Other: ❑ I AM OPTING TO INSTALL MULTIPLE DOMESTIC WATER IRRIGATION: 03/4" 01" 02" ❑Other: SERVICES FOR MY MULTI-FAMILY DEVELOPMENT UNDER ❑ FIRE: 01" 02" 04" 06" 08" ❑Other: SINGLE OWNERSHIP. FILL OUT REVERSE SIDE OF THIS FORM. ❑ DOMESTIC/FIRE COMBO: ❑1" 02" ❑Other: f',I r CONTACT INFORMATION A OWNER NAME: M lit '/' j}4/1,ill TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET ei gox 4/6 CITY ' it STATE 04 ZIP IWO g 3 OWNER PHONE: �2�-9'f$ -3 '& OWNER EMAIL: 1 'e�Mr q/Pk r+/°l..oro CONTRACTOR NAME: GPI I l./5 (/ S, ) le51.`-C VV CONTRACTOR ADDRESS: /STREET p(f Bp J I / P ,1 {CIIT1Y�j,,� -i rtle i:.i.k STATE UI/1 ZIP 0g0 U 3 CONTRACTOR PHONE: r l eil tS 'J 3% CONTRACTOR EMAIL: f .- (PtJ12e 'L� /�r4(}0- CONTRACTOR LIC.#(REQUIRED): .(�- Sit/—S3 ' 1 CITY OF EVERETT BUSINESS Lt .#(REQUIRED):4 7- T/q PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: /42,f-gitg ?5-6- IiA t /ill CONTACT EMAIL: I TJ/ , , eri-hrte /it,( (in AGREEMENT:The ndersigned applicant agrees to comply with all provisions of the Everett Municipal Code Title 14 Water and Seder or such other rules and regulations now existing or which m. 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 authorized by the owner of this property to perform the work for which application is made,and I comply with the State Contractors Law 18.27 RCW and 296.200A WAcd,' City of Everett Official U. only PERM # /147 /o� )/2/ U t o. .v 12 Owner/Au orized Agent Signature Date (Revise. ' • '021)