4330 CRESCENT AVE 2024-11-08 - Laserfiche WebLink

WATER I SEWER UTILITY APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETT SUBMITTAL INSTRUCTIONS Drop off hard copy paper application a plans to 3200 Cedar Street 2nd Floor Intake Drop Box WASHINGTON CONTACT INFORMATION(P)425-257-8810 1(E)PermilServices@everettwa gov I(W)everettwi gov/permits PROJECT SITE INFORMATION / PROJECT ADDRESS: L- 33 C) (-e S L C� f c L� �t i�� Cif it O LT — D IF APPLICABLE: ❑OUTSIDE CITY LIMITS ❑ BUILDING AREA SF ❑LOT I$ BUILDING TYPE FR ❑TOWNHOUSE ❑DUPLEX DADU ❑MULTI-FAMII Y#OF UNITS ❑COMMLRCIAL ❑ACCESSORY CHANGE OF USE? ❑NO ❑YES, FROM TO UTILITY APPLICATION INFORMATION SEWER(check all that apply) WATER(check all that apply) O SIDE SEWER REPAIR O BACKFLOW PREVENTION(Outside)-Specify device typo below ❑SIDE SEWER ALTERATION ORPBA(dom) ❑DCVA(dom) ❑DCVA(ur) ❑DCDA(fire) NEW SIDE SEWER INSTALLATION O WATER LINE BEHIND METER(repair or alteration) ❑INSTALL BACKWATER VALVE(outside the building) ❑NEW WATER SERVICE INSTALLATION ❑SIDE SEWER CAP-OFF Specify installation typo below: ❑SIDE SEWER RECONNECTION ❑NEW COMPLETE SERVICE MULTIPLE DOMESTIC WATER SERVICES REQUEST ❑METER ONLY ❑1 AM DECLINING MULTIPLE DOMESTIC WATER SERVICES FOR Specify water service type B size below: MY MULTI-FAMILY DEVELOPMENT UNDER SINGLE OWNERSHIP ❑DOMESTIC ❑3/4" *- ❑2' ❑Other ❑I AM OPTING TO INSTALL MULTIPLE DOMESTIC WATER ❑IRRIGATION 03/4" Or 02' ❑Other SERVICES FOR MY MULTI-FAMILY DEVELOPMENT UNDER ❑FIRE 01" 02' 04" 06" 08" ❑Other SINGLE OWNERSHIP FILL OUT REVERSE SIDE OF THIS FORM. ❑DOMESTIC/FIRE COMBO 01' 132" ❑Other r �1 CONTACT INFORMATION !�(OWNER NAME: r} L L_ L— TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET /l JI ^ /I /CITY OWNER PHONE: Ll L OWNER EMAIL: CSC D CONTRACTOR NAME: 6- i (� t 0L e c� CONTRACTOR ADDRESS: sTRFITJJ (� (3 d I STATE W V7 ZAP �5 CONTRACTOR PHONE: Ll�L /�QU to CONTR,A L� \CTOR EMAIL: .v L' I `l CJ c�• Lir t!,C L�•ti CONTRACTOR LIC.#(REQUIRED): T ln' �J L 2 r� 3 V CITY OF EVERETT BUSINESS LIC.kREQUIRED) PRIMARY CONTACT: ❑OWNER kCONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: t CONTACT PHONE: L I"6,/ CONTACT EMAIL: i L 1 x`✓ %L. lc yt C Q�'vl AGREEMENT The unders;gned applicant agrees to comply with oil provisions of the Everett Mun rpal CodeLWe'14 Water and ewer 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 recervmg service that the utilities division shall have the right at any lime,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 plow er 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# 3 � -3 3 U Owner/Authorized Agent Signature Date (Revised 41212022) -- w ..�-