320 S CABOT RD 2023-01-26 - Laserfiche WebLink

WADER / SEWER UTILITY APPLICATION .77 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: 320 S. Cabot Rd. IF APPLICABLE: ❑ OUTSIDE CITY LIMITS © BUILDING AREA--2,00 SF ❑ LOT#67 BUILDING TYPE: ?1SFR ❑TOWNHOUSE ❑DUPLEX ❑ADU ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL ❑ACCESSORY CHANGE OF USE? CZ NO ❑YES, FROM TO UTILITY APPLICATION INFORMATION SEWER (check all that apply) WATER (check all that apply) ❑SIDE SEWER REPAIR ❑NEW WATER SERVICE INSTALLATION ❑SIDE SEWER ALTERATION ❑ COMPLETE SERVICE ❑METER ONLY ❑NEW SIDE SEWER INSTALLATION SERVICE/METER USE: ❑INSTALL BACKWATER VALVE(outside the building) ❑✓ SFR W]SIDE SEWER CAP-OFF ❑MULTI-FAMILY-#OF UNITS: ` R' ONNECTff7N - Li COMMERCIAL MULTIPLE DOMESTIC WATER SERVICES REQUEST WATER SERVICE TYPE/SIZE: (provide calcs to support size choice) ❑I AM DECLINING MULTIPLE DOMESTIC WATER SERVICES FOR ❑ DOMESTIC: 03/4" 1111" 1112" ❑Other: MY MULTI-FAMILY DEVELOPMENT UNDER SINGLE OWNERSHIP. ❑ IRRIGATION: 03/4" 01" 1112" ❑Other: ❑I AM OPTING TO INSTALL MULTIPLE DOMESTIC WATER ❑FIRE: 01" ❑2" ❑4" 1116" ❑8" ❑Other: SERVICES FOR MY MULTI-FAMILY DEVELOPMENT UNDER ❑ DOMESTIC/FIRE COMBO: ❑1" ❑2" ❑Other: SINGLE UWNEI-SHIP. FILL OUT REVERSE SIDE OF THIS FORM. ❑13ACKl-LOVV PREVENTION (Outside): URPBA ❑DCDA LJDCVA CONTACT INFORMATION OWNER NAME: Marc Fogg TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET318 S. Cabot Rd. CITY Everett STATE WA zIP 98203 OWNER PHONE:425.:iUti.5blY (OWNER EMAIL:fogg.marc(a)gmail.com CONTRACTOR NAME:LEXAR Homes CONTRACTOR ADDRESS: STREET 3721 116th Street NE, Ste 9 ciTY Marysville STATE WA ZIP 98271 CONTRACTOR PHONE:360.657.1968 CONTRACTOR EMAIL:walkerconstructionbuilder@gmail.com "IAITRACT(IR I I(' ff(oCrnl IloEn).LEXARH*85ONC IrITv(IF F\,FRGTT RI ICIrIGCC I It` 4#iocr,I IIDC PRIMARY CONTACT: ❑ OWNER ❑CONTRACTOR ❑✓ OTHER(Please Specify) Consultant-Smith Land Development Services`- --- CONTACT NAME: CONTACT PHONE:425.238.6324 Stacy Smith 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 existi 'ch 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 a time,witho ice,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 autnonzed uy irre ow ier of fins property to perform lire work for winch appiivaiiori is rnaoe,arxi i comply wilt!irre Sidle Contractors%aw 16.27 icc.v'v and 29o.200A'vvAC. City of Everett Official Use Only PERMIT# er/Auth i d A Signature ate (Revised 10/12/2018)