8907 5TH AVE W 2023-04-11 - Laserfiche WebLink

TER047.7. I S EWER UTILIT, PPLICATION 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: •8 EVERETT WA 98204 579 C 9— , IF APPLICABLE: ❑ OUTSIDE CITY LIMITS R1 BUILDING AREA 6039 sf clearing area SF ❑LOT# BUILDING TYPE: VISFR ❑TOWNHOUSE ❑DUPLEX ❑ADU ❑MULTI-FAMILY-#OF UNITS: I1COMMERCIAL HACCESSORY CHANGE OF USE? n NO Li YES, FROM TO UTILITY APPLICATION INFORMATION SEWER(check all that apply) WATER(check all that apply) L i SIDE SEWER REPAIR ✓❑NEW WATER SERVICE INSTALLATION ❑SIDE SEWER ALTERATION Iv l COMPLETE SERVICE METER ONLY ❑ NEW SIDE SEWER INSTALLATION SERVICE/METER USE: ❑ INSTALL BACKWATER VALVE(outside the building) V SFR • ❑SIDE SEWER CAP-OFF LI MULTI-FAMILY-#OF UNITS: SIDE SEWER RECONNECTION ❑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" El" ❑2" ❑Other: MY MULTI-FAMILY DEVELOPMENT UNDER SINGLE OWNERSHIP. ❑ IRRIGATION: 03/4" ❑1" 02" ❑Other: I AM OPTING TO INSTALL MULTIPLE DOMESTIC WATER ❑ FIRE: ❑1" ❑2" ❑4" 06" ❑8" ❑Other: SERVICES FOR MY MULTI-FAMILY DEVELOPMENT UNDER LJ DOMESTIC/FIRE COMBO: ❑1" 02" ❑Other: SINGLE OWNERSHIP. FILL OUT REVERSE SIDE OF THIS FORM. ❑BACKFLOW PREVENTION(Outside): ❑RPBA ❑DCDA ❑DCVA CONTACT INFORMATION OWNER NAME: BOYKO ROSTISLAV TENANT BUSINESS NAME (If Commercial): OWNER MAILING ADDRESS: STREET 12029 24TH AVE SE CITY Everett STATE WA ZIP 98208 OWNER PHONE:425-344-6348 OWNER EMAIL:interiorwa@gmail.com CONTRACTOR NAME:Unknown at this time CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): PRIMARY CONTACT: R✓I OWNER ❑CONTRACTOR Li OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:425-344-6348 BOYKO ROSTISLAV CONTACT EMAIL:interiorwa@gmail.com 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 perform the work for which application is made,and I comply with t ,State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only • PERMIT# I V 04-04-22 Owner/Authorized en ignature Date (Revised 10/12/2018)