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WATER I SEWER UTILITY APPLICATION <br />CITY OF EVERETi PERMR SERVICES <br />EVERETT SUBMITTALINSTRUCTIONS: Drop off haul ropy paper application plans W MO Cofer Street 2nd Floor Intake Drop Box. <br />WASHINGTON CONTACT INFORMATION: (P)426. 57.88101(E) l AB) everettwaGovlpermaz <br />PROJECT SITE INFORMATION <br />PROJECTADDRESS: 1414 <br />5D-SS <br />Z <br />IF APPLICABLE: ❑ OUTSIDE CITY LIMITS 0 BUILDING AREA SF ❑LOT# <br />BUILDING TYPE: SFR OTOWNHOUSE ODUPLE% OADU OMULTFFAMILY40FUNITS� OCOMMERCIAL 0ACCESSORY <br />CHANGE OF USE? NO ❑YES, FROM TO <br />UTILITY APPLICATION INFORMATION <br />SEVIER(Check all that apply) <br />WATER check all that apply <br />❑ SIDE SEWER REPAIR <br />❑ SIDE SEWER ALTERATION <br />❑ NEW SIDE SEWER INSTALLATION <br />❑INSTALL BACHWATER VALVE (outside buildilg) <br />❑SIDESEWERCAP-OFF <br />❑ SIDE SEWER RECONNECTION <br />❑ BACKFLOW PREVENTION (Outslde)- Specify devices, type below: <br />ORPBA(dom.) ODCVA(dom.I ODCVA(Irr.) ODCDAfII <br />❑ WATER LINE BEHIND METER (Wait or altandsml)],.�. - <br />❑NEWWATERSERVICEINSTALLATION' V) T I!' ✓� <br />Specify huhllatlon type below: u/I Cj(�in, <br />❑ NEW COMPLETE SERVICE 3//4" <br />❑METER ONLY Gn r10.1�W <br />Spedty waterservice type& size below: I IKS,/R(/�/ <br />❑DOMESTIC: 133IV' Oi" O2" DOlher: <br />IRRIGATION: 03W 01" 07 OOther: <br />❑FIRE: 01'02' 126' OB' Da-LJOmer <br />OMESTICIFIRE COMBO: 1" 0T' JEBI <br />MULTIPLE DOMESTIC WATER SERVICES REQUEST <br />❑ I AM DECLINING MULTIPLE DOMESTIC WATER SERVICES FOR <br />MY MULTI -FAMILY DEVELOPMENT UNDER SINGLE OWNERSHIP. <br />❑ I AM OPTING TO INSTALL MULTIPLE DOMESTIC WATER <br />SERVICES FOR MY MULTIFAMILY DEVELOPMENT UNDER <br />SINGLE OWNERSHIP. FILL OUTREVERSE SIDE OF THIS FORM. <br />CONTACT INFORMATION <br />OWNERNAME: <br />TENANT BUSINESS NAME If Commercial: <br />OWNER MAILING ADDRESS: <br />S 1 Ei <br />t <br />Go 9 263 <br />OWNERPHONE: <br />Q <br />H I <br />OWNEREMAIL: Q D IYI <br />CONTRACTOR NAME: — C <br />1 <br />CONTRACTOR ADDRESS: banner <br />0" Gets 71P <br />CONTRACTOR PHONE: <br />CONTRACTOREMAIL <br />CONTRACTOR LIC.#(PEOUREO): <br />- SI <br />! qp <br />CITY OF EVEREFT BUSINESS LIC. .6 /REQUIREDJ <br />PRIMARYCONTACE ❑OWNER ❑CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: / <br />CONTACT PHONE; C J� CID - -p I <br />CONTACT EMAIL: t7rU N+CTAI^ <br />AGREEMEW..'Tha untlemlpnetlaryd'ertpreetfocamp1y u11b eY pav3bne MINT Cause AnAbIka Cada)It 14 Wedrentl5ewafauMolbeflukt entlrepubLWammv <br />exBNi9 w whMlmv be ealM4aaetl! (Me to was. aronMlkn paredenllonwMvpwrvke llwl MeullNlNa dMtbn ells.VMwlbadNMe1 <br />any0me. wbMul ndke, balwl ofl MlumanlM robf soppy lw lwMx roneluibn keanonpeyma lM thepdaorMaW MMflo+V127R cavm.lam Ns amn, orlem <br />aultlodzotlbY tM omM/afMk pOpMYlo Mtloml lbexork la whkh gW4oetknlennbe, eMlrompy AWN IM1e a1Ne(uMmUom Lew 1fl})HCW entli982G0A WAG <br />CO alErerell O?clelUmO <br />PERMDH <br />0I126123 U 2301-037 <br />ownanAUmo en Ionawre Uem asIdedleAGO21) <br />)0 <br />s+' <br />