Laserfiche WebLink
WATER / SEWER UTILITY APPLICATION <br />CITY OF EVERETL PERMIT SERVICES <br />E V E R E T T <br />SUBMITTAL INSTRUCTIONS: Drop oil hard copy paper application 8 plans or 32W Coder Slrem 2nd Floor Intake Drop Box. <br />WASHINGTON <br />CONTACT INFORMATION: (P) 426-267d8101(E) PennitServlces@everethim gov I (W) eaereLLwa.gov/Pormtls <br />PROJECT SITE INFORMATION <br />PROJECT ADDRESS: 2626 Grand Ave, Everett, WA 98201 <br />IFAPPLICABLE: ❑ OUTSIDE CITY LIMITS ❑ BUILDINGAREA SF ❑ LOT IF ON39161601 NO <br />BUILDING TYPE: QSFR 13TMNHOUM ODUPLEX OADU OMULTI-FAMILYMOF UNITS: 13COMMERCIAL 13ACCESSMY <br />CHANGE OF USE? NO ❑ YES, FROM TO <br />UTILITY APPLICATION INFORMATION <br />SEWER (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 BACKWATER VALVE(ootsitle Nebulldig) <br />❑ SIDE SEWER CAP -OFF <br />O SIDE SEWER RECONNECTION <br />O BACKFLOW PREVENTION (Outside) - SpecPytlavice rype below: <br />ORPBA(dam) ODCVA(dom) ODCVA(IIT) ODCDARGI <br />O WATER LINE BEHIND METER(repairor alteration) <br />❑ NEW WATER SERVICE INSTALLATION <br />Specify histallallon type Wow. <br />❑ NEW COMPLETE SERVICE <br />❑ METER ONLY <br />Specify water service type 8 size below: <br />❑DOMESTIC: O3sr O1" Or OOlher <br />❑IRRIGATION: 03/4' OP OT 001her: <br />❑FIRE: 01' 02" 04' 06" 08" OOmer: <br />❑ DOMESTICIFIRE COMBO: ❑1" 02" OOmer <br />MULTIPLE DOMESTIC WATER SERVICES REQUEST <br />O 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 MULTI -FAMILY DEVELOPMENT UNDER <br />SINGLE OWNERSHIP. FILL OUTREVERSE SIDE OF THIS FORM <br />CONTACT INFORMATION <br />OWNER NAME: Shannon VOtaw TENANT BUSINESS NAME If Commercial): <br />OWNER MAILING ADDRESS: ,a,,2626 Grand Ave <br />Everett STATE WA zip 98201 <br />OWNER PHONE: 817-734-1115 <br />OWNEREMAIL shannOnIvactawrommail.com <br />CONTRACTOR NAME: <br />CONTRACTOR ADDRESS: STREET <br />For STATE ZIP <br />CONTRACTOR PHONE: <br />CONTRACTOREMAIL: <br />CONTRACTOR LIC.%REONRED: CITY OF EVERETT BUSINESS LIC. #GEOi <br />PRIMARYCONTACT: VOWNER ❑CONTRACTOR ❑ OTHER(Plaasa Specify) <br />CONTACT NAME: <br />CONTACT PHONE: <br />CONTACT EMAIL: <br />AGREEMENT -TM untlerelgnMep,AceMepm brdnpjuVM aNproviehv WMe Evextl MunlepN Lak Tpk la WeW UM Sexn'd.a.M aMie'n.Yes ant reptleLvanS rww <br />way irgw himdess8ae9feblisM1stlfimm WINb Mia. TM1eaPF'Mc'anl(wlM1wa8rses,a5acmdAonpeRdaMb AttivmB MYic'etM1NtlIBWNreS dm'SOnsMphMIMr IMal <br />anYWIN, wllM1cul^arica. fa SrNld(w Wm an IM1e wala-assPi'Mrep earcros is ann.er an y INSM1wguwManours La 1827A K/m.l N5I20Aa .wlan <br />aNM1wlewlb/tlN mmero/tMs gomMbpe:/ th wwk brwMCM1 applkYkn lS maEe. an01 �'IWy mM llre$lore CwNectlws Lew lB.P]RCW aMPB6TOMWAG <br />C 0(Everetl OflkklUm On <br />PERMITC <br />07/12123 u <br />Oxnar/AUMwIzetl A8xrt818laWre Dele (Revisedi 12022) <br />