8514 SHADOW WOOD DR LOT 3 2023-08-01

WAR / SEWER UTILITY AFOLICATION CITY OF EVERETT PERMIT SERVICES EVERETT SUBMITTAL INSTRUCTIONS:Drop off hard copy paper application&plans to 3200 Cedar Street 2nd Floor Intake Drop Box. CONTACT INFORMATION:(P)425-257-8810 1(E)PermitServices@everettwa.gov I(W)everettwa.gov/permits WASHINGTON PROJECT SITE INFORMATION PROJECT ADDRESS: 8514 Shadow Wood Dr Everett �0'f 3 t I S hcj SF IF APPLICABLE: E OUTSIDE CITY LIMITS 0 BUILDING AREA SF ❑ LOT#Old Existing House BUILDING TYPE: 12ISFR ❑TOWNHOUSE DUPLEX ❑ADU ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL ❑ACCESSORY CHANGE OF USE? ❑ NO 0 YES, FROM TO UTILITY APPLICATION INFORMATION SEWER(check all that apply) WATER(check all that apply) ❑SIDE SEWER REPAIR ❑ BACKFLOW PREVENTION(Outside)-Specify device type below: ❑SIDE SEWER ALTERATION ❑RPBA(dom.) ❑DCVA(dom.) ❑DCVA(irr.) ❑DCDA(fire) El NEW SIDE SEWER INSTALLATION ❑WATER LINE BEHIND METER(repair or alteration) ❑ INSTALL BACKWATER VALVE(outside the building) KNEW WATER SERVICE INSTALLATION ?� 1,0Z ❑SIDE SEWER CAP-OFF Specify installation type below: ❑SIDE SEWER RECONNECTION 0 NEW COMPLETE SERVICE MULTIPLE DOMESTIC WATER SERVICES REQUEST 0 METER ONLY L v 0 I AM DECLINING MULTIPLE DOMESTIC WATER SERVICES FOR Specify water service ty•- ,s' a below: MY MULTI-FAMILY DEVELOPMENT UNDER SINGLE OWNERSHIP. Cs DOMESTIC: 03/4", ❑2" ❑Other: i .%c..' ❑ I AM OPTING TO INSTALL MULTIPLE DOMESTIC WATER 0 IRRIGATION: a /4" ❑1" 02" ❑Other: SERVICES FOR MY MULTI-FAMILY DEVELOPMENT UNDER ❑FIRE: 01" 1:12" ❑4" 06" ❑8" ❑Other: SINGLE OWNERSHIP.FILL OUT REVERSE SIDE OF THIS FORM. 0 DOMESTIC/FIRE COMBO: 01" 02" ❑Other: CONTACT INFORMATION OWNER NAME: Ahmet Kulaga TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 1315 131st SE Unit B cm, Everett STATE WA ZIP 98208 OWNER PHONE:425-501-6441 OWNER EMAIL: kulaga425@gmail.com CONTRACTOR NAME:Reliable Construction CONTRACTOR ADDRESS: STREET3210 162nd PL SE CITY Bellevue STATE WA ZIP 98008 CONTRACTOR PHONE:Reliable Costruction CONTRACTOR EMAIL:reliable-construction@comcast.net CONTRACTOR LIC.#(REQUIRED):RELIAC*193P2 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): PRIMARY CONTACT: El OWNER 0 CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: Ahmet Kulaga CONTACT PHONE:425-501-6441 CONTACT EMAIL:kulaga425@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 the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only �i PERMIT# ,cQ/,ilt.Q A April 6 2023 U O T d O Owner/Authorized Agent Signature Date (Revised 4/21/2022)