Laserfiche WebLink
WATER I SEWER UTILITY APPLICATION <br />CITY OF EVERETTPERMITSERVICES <br />EVERETT SUBMITTALINSTROCTI011 Drop off had war pepereppllcelbnB plans b32000etlw Slructind Floorintake Orvp9Oz <br />WARRINQTnO CONTACT INFORMATION: (P)425.25T.9B101(E)PervnllServktsWeverellwa.9ov I DAD) arelhva.9ovtyermlla <br />PROJECT SITE INFORMATION <br />PRGIECTADDRESS: <br />O <br />IFAPPLICAII ❑ OUTSIDE CITY LIMITS ❑ BUILDING AREA SF ❑ LOT III <br />BUILDINGWPE: OSFR OTOWNHOUSE ODUMEX OADU 0MULTIFAMILY40FUNITS: OCOMMERCIAL OACCESSORY <br />CHANGE OF USE? O 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(oalaltle the bolltling) <br />❑ SIDE SEWER CAP -OFF <br />❑ SIDE SEWER RECONNECTION <br />❑ BACKFLOW PREVENTION (Octaltle) - Specify device type below: <br />ORPBARtim) nDCVAMI ODCVADR.) ODCDAMI <br />WATER LINE BEHIND METER( repair or alteration) <br />O NEW WATER SERVICE INSTALLATION <br />Speiffy lasMlla#oR type below: <br />❑ NEW COMPLETE SERVICE <br />❑METER ONLY <br />Specify preferseMw type S size below: <br />❑DOMESTIC: 0341' OF 02' OOther: <br />IRRIGATION: 0314" ❑1" O2' OOlher: <br />❑FIRE: O1" nT' nb' OD" OB" OOIM1er: <br />❑ WMESTICIFIRE COMBO: ni' 02' DOIM1er: <br />MULTIPLE DOMESTIC WATER SERVICES REQUEST <br />❑ I AM DECLINING MULTIPLE DOMESTIC WATER SERVICES FOR <br />MY MULTIFAMILY 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 OUT REVERSE SIDE OF THIS FORM. <br />CONTACT INFORMATION <br />OWNER NAME: TENANT BUSINESS NAME (If Commerclal): <br />OWNER MAILING ADDRESS: % } <br />mar STAIrs 4fl,O <br />OWNER PHONE: — <ZIC OWNEREMAIL: <br />CONTRACTORNAME: ow &— WO I <br />CONTRACTOR ADDRESS: <br />CONTRACTOR PHONE: <br />CONTRACTOREMAIL: <br />CONTRACTOR LIC. p REOUIREDI: CITY OF EVERETT BUSINESS LIC. #(REQUIRED): <br />PRIMARY CONTACT ❑OWNER ❑CONTRACTOR ❑ OTHER (Please Speedy) <br />CONTACT NAME: <br />CONTACT PHONE: <br />ON CTACTEMAIL: <br />AGREEMENT: ITeuvMrsipneaappMeNepreetbmryly M announce Of EVBNtl Muaklpel Cgao AM 19 WalweMSexerwvuNWlwtwee maregulelbnf my <br />marks Or sees may be Oreaccu it seem Ilme M arm. nomorecomf FartM1n aimeeA as a Panama precebl bremaMg xiWe Mn the WMka gvisM Mae him lse rose 0l <br />amlNre, "mass nonce. IOanWMwlammllre welwaaTyb Fwr paNa, imagination, enaawpaynreMaaeerpAwls enr olberreamneNe cause Ivntlredma'. crime <br />ammmedby lm ownwCook, womeyb covers ba uses for Were, ampbumbe k mere, anaimmmy was me slab Coneamob One lase RMand tM12pw WAC. <br />Cher aEwnn OMcNI Usa ONy <br />PERMIT# <br />Aa'wl fezod P/2-2� UL30 -OzZ <br />OwnerAuthorua Agent SibneWre Ism, (ReWetlaH/M2N <br />