6209 2ND DR SE 2024-03-29 - Laserfiche WebLink

I• EVERETT WASHINGTON WATER I SEWER UTILITY APPLICATION CITY OF EVERETT PERMIT SERVICES SUBMITTAL INSTRUCTIONS: Drop off hard copy paper application & plans to 3200 Cedar Street 2nd Floor Intake Drop Box. CONTACT INFORMATION: (P) 426.267,8810 1(E) PermltServices@everettwa.gov I (W) everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 6209 2nd DRIVE SOUTH EAST - EVERETT WA 98203 IF APPLICABLE: ❑ OUTSIDE CITY LIMITS ❑ BUILDING AREA SF ❑ LOT # BUILDING TYPE: I]SFR ❑TOWNHOUSE ❑DUPLEX ❑ADU ❑MULTI -FAMILY -#OF UNITS: ❑COMMERCIAL ❑ACCESSORY CHANGE OF USE? ❑✓ NO ❑ YES, FROM TO UTILITY APPLICATION INFORMATION SEWER (check all that apply) WATER (check all that apply) ❑ SIDE SEWER REPAIR 0 SIDE SEWER ALTERATION ❑ NEW SIDE SEWER INSTALLATION CI INSTALL BACKWATER VALVE (outside the building) ❑ SIDE SEWER CAP -OFF ❑ SIDE SEWER RECONNECTION ❑ 13ACKFLOW PREVENTION (Outside) - Specify device type below: ❑RPBA (dom.) ❑DCVA (dom.) ❑DCVA (irr.) ❑DCDA (fire) ❑ WATER LINE BEHIND METER (repair or alteration) ❑ NEW WATER SERVICE INSTALLATION Specify Installation type below: ❑ NEW COMPLETE SERVICE CI METER ONLY Specify water service type & size below: ❑ DOMESTIC: 0314" 01" 02" ❑Other : IRRIGATION: 0314" ❑l" 112" ❑Other : ❑ FIRE: ❑l" 132" L74" 136" 08" ❑Other : ❑ DOMESTIC/FIRE COMBO: ❑l" 02" ❑Other : MULTIPLE DOMESTIC WATER SERVICES REQUEST ❑ 1 AM DECLINING MULTIPLE DOMESTIC WATER SERVICES FOR MY MULTI -FAMILY DEVELOPMENT UNDER SINGLE OWNERSHIP. ❑ I AM OPTING TO INSTALL MULTIPLE DOMESTIC WATER SERVICES FOR MY MULTI -FAMILY DEVELOPMENT UNDER SINGLE OWNERSHIP. FILL OUT REVERSE SIDE OF THIS FORM. CONTACT INFORMATION OWNER NAME: DAVID HARTWIG TENANT BUSINESS NAME (If Commercial): OWNER MAILING ADDRESS: STREET6209 2ND DRIVE SOUTH EAST ow EVERETT STATE WA zip 98203 OWNER PHONE-14252631232 1OWNER EMAIL: enigma_60097@yahoo.com CONTRACTOR NAME: JIM DANDY SEWER & PLUMBING CONTRACTOR ADDRESS: STREET6202 214th St SW ,,, Mountlake Terrace STATE WA zip 98043 CONTRACTOR PHONE: 7147601358 CONTRACTOR EMAIL: dispatch@jimdandysewer.com CONTRACTOR LIC. #(REQUIRED):JIMDADS879B3 CITY OF EVERETT BUSINESS LIC. # REQUIRED : 056702 PRIMARY CONTACT: ❑ OWNER ® CONTRACTOR ❑ OTHER (Please Specify) CONTACT NAME: CHRIS KAPELLAS CONTACT PHONE: 7147601358 CONTACT EMAIL:dispatch@jimdandysewer.com AGREEMENT.., The undersigned applicant agrees to comply with all provislons of the Everett Municipal Code Title 14 Water and Sewer ar 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 chargas or for any other reasonable cause. l am the owner, or l am authorized by the owner of this properly to perform the work for which application is made, and l comply with the State Contractors Law 18.27 RCW and 298.200A WAC. of Everett Official Use 10/28/2021 Owner/Authorized Age nrSlgfiature - — " Date Replaced with PW2111-035. Scope of work has not changed.