4817 RUCKER AVE 2024-12-09 - Laserfiche WebLink

WATER / SEWER UTILITY APPLICATION EVERETT 32CITY OF EVERETT PERMIT SERVICES 00 CEDAR STREET, EVERETT,WA 98201 WASHINGTON (P)425-257-8810 1 FAX 425-257-8857 1 (E)everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 4817 Rucker Avenue IF APPLICABLE: ❑ OUTSIDE CITY LIMITS ❑ BUILDING AREA SF ❑ LOT# BUILDING TYPE: ❑SFR ❑TOWNHOUSE ❑DUPLEX ❑ADU ❑MULTI-FAMILY-#OF UNITS: °❑COMMERCIAL ❑ACCESSORY CHANGE OF USE? 0 NO ❑YES, FROM TO UTILITY APPLICATION INFORMATION SEWER (check all that apply) WATER(check all that apply) ❑SIDE SEWER REPAIR 0 NEW WATER SERVICE INSTALLATION ❑SIDE SEWER ALTERATION ZI COMPLETE SERVICE ❑METER ONLY ❑ NEW SIDE SEWER INSTALLATION SERVICE/METER USE: ❑ INSTALL BACKWATER VALVE(outside the building) ❑SFR ❑SIDE SEWER CAP-OFF ❑MULTI-FAMILY-#OF UNITS: ❑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 ❑ DOMESTIC: ❑3/4" 1-I1" ❑2" ❑Other: MY MULTI-FAMILY DEVELOPMENT UNDER SINGLE OWNERSHIP. 0 IRRIGATION: ❑3/4" Or 02" ❑Other: ❑I AM OPTING TO INSTALL MULTIPLE DOMESTIC WATER ❑ FIRE: Or ❑2" ❑4" ❑6" ❑8" ❑Other SERVICES FOR MY MULTI-FAMILY DEVELOPMENT UNDER ❑ DOMESTIC/FIRE COMBO: Or ❑2" ❑Other: SINGLE OWNERSHIP. FILL OUT REVERSE SIDE OF THIS FORM. ❑BACKFLOW PREVENTION (Outside): ❑RPBA ❑DCDA ❑DCVA CONTACT INFORMATION OWNER NAME: City of Everett(Parks and Community Services) TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STIEET802 E. Mukilteo Blvd. CITY Everett STATE WA ZIP 98203 OWNER PHONE:425 257-8378 OWNER EMAIL: CONTRACTOR NAME:RRJ Contractors, LLC CONTRACTOR ADDRESS: STREET PO BOX 607 CITY Monroe STATE WA zlp 98272 CONTRACTOR PHONE:360-805-8246 CONTRACTOR EMAIL:rrjwelcome@gmail.com CONTRACTOR LIC.#(REQUIRED):RRJCORJ97OPC CITY OF EVERETT BUSINESS LIC.#(REQUIRED): PRIMARY CONTACT: 0 OWNER ❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:425 257-8378 Mark Harrison CONTACT EMAIL:MharriSOn@everettwa.gOV 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 1 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# 3-29-2021 U Owner/Authorized Agent Signature Date (Revised 1011212018)