535 VIEW RIDGE DR 2025-03-31 - Laserfiche WebLink

WATER / SEWER UTILITY APPLICATION CITY OF EVERETT PERMIT SERVICES EVERETT SUBMITTAL INSTRUCTIONS: Drop off hard copy paper application&plans to 3200 Cedar Street 2nd Floor Intake Drop Box. WASHINGTON CONTACT INFORMATION: (P)425-257-8810 1(E) PermitServices@everettwa.gov I(W)everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: �� ' 1 f-t.J j E IF APPLICABLE: ❑ OUTSIDE CITY LIMITS BUILDING AREA JSC SF V1 LOT# �o BUILDING TYPE: ZSFR ❑TOWNHOUSE ❑DUPLEX ❑ADU ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL ❑ACCESSORY CHANGE OF USE? Z NO ❑YES, FROM TO UTILITY APPLICATION INFORMATION SEWER (check all that apply) WATER(check all that apply) ❑ SIDE SEWER REPAIR ❑ BACKFLOW PREVENTION (Outside)-Specify device type below: ❑SIDE SEWER ALTERATION ❑RPBA(dom.) ❑DCVA(dom.) ❑DCVA(irr.) ❑DCDA(fire) ❑ NEW SIDE SEWER INSTALLATION ❑WATER LINE BEHIND METER(repair or alteration) ❑ INSTALL BACKWATER VALVE(outside the building) NEW WATER SERVICE INSTALLATION$� ❑ SIDE SEWER CAP-OFF Specify installation type below: r /tIc� bd SIDE SEWER RECONNECTION ❑ NEW COMPLETE SERVICE MULTIPLE DOMESTIC WATER RVICES REQUEST ❑ METER ONLY Specify water service type&size below: r IRE ❑ I AM DECLINING MULTIPLE DO STIC WATER SERVICES FOR p y YP MY MULTI-FAMILY DEVELOP NT I�NDER SINGLE OWNERSHIP. El DOMESTIC: ❑3/4" 01" ❑2" ❑Other: ❑ I AM OPTING TO INS L MULTIPLE DOMESTIC WATER El IRRIGATION: ❑3/4" 01" 02" ❑Other: SERVICES FOR MULTI-FAMILY DEVELOPMENT UNDER ❑ FIRE: ❑1" 02" ❑4" 116" ❑8" ❑Other: SINGLE OWNERSHIP. FILL OUT REVERSE SIDE OF THIS FORM. DOMESTIC/FIRE COMBO: 1" ❑2" ❑Other: CONTACT INFORMATION OWNER NAME: of S -6 e C for L L TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET �� y '7 r� 14V F sr:, ///^' �yg CITY < STATE ( A ZIP OWNER PHONE: e9211'S> f7<2�— OWNER EMAIL: 4, CONTRACTOR NAME: CONTRACTOR ADDRESS: STREET/ �b`ZV n` e Aj - CITY L�ko STATE ZIP 7—S CONTRACTOR PHONE: C _S= R 7-IZ1 I Z ` CONTRACTOR EMAIL: r<,' th A r , / C � MA i/r CONTRACTOR LIC.#(REQUIRED): 5�7_1 I-(./ At q!7?_ C_D CITY OF EVERETT BUSINESS LIC.#(REQUIRED): PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: }� CONTACT PHONE: �'.L —'7'7-3 _ v /-Z, /�/ r� /�� 5c•`;/� �J�-ai? CONTACT EMAIL: .i eJAJ �41 r itt. C.p AGREEMENT:The undersigned i a� nt agrees to comply with aYl provisions of the Everett Municipal Code Title 14 Wate a d Sewe{, r such other riles and regulations now existing or which maybe esiabiishe from time to time. The applicant further agrees,as a condition precedent to receiving service that the utilities division shalt 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.1 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 PCrMIT# Owner/Ruth ize I Agent Signature Date (Revised 412112022)