4916 24TH AVE W 2024-08-06 - Laserfiche WebLink

IMO WATER / SEWER UTILITY APPLICATION imi EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 4916 24TH AVE. W., EVERETT WA 98203 IF APPLICABLE: ❑OUTSIDE CITY LIMITS © BUILDING AREA 2489 SF l LOT#4 BUILDING TYPE: ❑✓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 ✓❑ NEW WATER SERVICE INSTALLATION El SIDE SEWER ALTERATION Cl COMPLETE SERVICE ©METER ONLY ©NEW SIDE SEWER INSTALLATION SERVICE/METER USE: ❑INSTALL BACKWATER VALVE(outside the building) CI SFR ❑SIDE SEWER CAP-OFF El MULTI-FAMILY-#OF UNITS: El SIDE SEWER RECONNECTION ❑COMMERCIAL MULTIPLE DOMESTIC WATER SERVICES REQUEST WATER SERVICE TYPE/SIZE: (provide calcs to support size choice) ❑I AM DECLINING MULTIPLE DOMESTIC WATER SERVICES FOR El DOMESTIC: 03/4" 01" 02" ❑Other: MY MULTI-FAMILY DEVELOPMENT UNDER SINGLE OWNERSHIP. ❑ IRRIGATION: 03/4" 01" ❑2" ❑Other: ❑I AM OPTING TO INSTALL MULTIPLE DOMESTIC WATER ❑FIRE: 01" 02" 04" 06" 08" ❑Other: SERVICES FOR MY MULTI-FAMILY DEVELOPMENT UNDER ❑✓ DOMESTIC/FIRE COMBO: ©1" ❑2" ❑Other: SINGLE OWNERSHIP. FILL OUT REVERSE SIDE OF THIS FORM. ❑BACKFLOW PREVENTION(Outside): ❑RPBA ❑DCDA ❑DCVA CONTACT INFORMATION OWNER NAME: 4900 24th Ave. W., LLC TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: sTREET526 N. West Ave. #147 CITY Arlington STATE WA zip 98223 OWNER PHONE:360-631-5922 x 3 OWNER EMAIL:officemanager@fUIIWilerCOnstrUCtion.COm CONTRACTOR NAME:Fullwiler Construction Inc. CONTRACTOR ADDRESS: STREETsame as above CITY STATE ZIP CONTRACTOR PHONE:Same as above CONTRACTOR EMAIL:Same as above CONTRACTOR LIC.#(REQUIRED):FULLWCI903M2 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): PRIMARY CONTACT: ❑OWNER ❑✓ CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:360-631-5922 x 3 /425-344-7803 Mallorie Hefley or Jerry Fullwiler CONTACT EMAIL:officemanager@fullwilerconstruction.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 PERMIT# c/(�e�z( UDI 01. - Owner/Authorized Agent I at fir Date (Revised 10/12/2018)