3331 HOYT AVE 2016-08-24 - Laserfiche WebLink

��`�� I ��9�1� ��'D�fl`�� '��9��`�9�� " C1TY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 � FAX 425-257-8857 �(E) everetteps@everettwa.gov � www.everettwa.gov/permits PROJECT ADDRESS: IF APPLICABLE: BUILDING TYPE: CHANGE OF USE? _,_ I'ROJEC7' S1�'E INFORIi�.A7'IOP�I ��-, �1 �7 � C l i 1/-�'� I� c''` �'= L'�<�' t��' �-�- ❑ OUTSIDE CITY LIMITS ❑ BUILDING AREA SF ❑SFR-DETACHED ❑SFR-ATTACHED ❑DULEX ❑MULTI-FAMILY-#OFUNITS: ❑ NO ❑ YES, FROM TO ❑ LOT # ❑COMMERCIAL ❑INDUSTRIAL lJi1LITl( �1PPLIC�4TIOid IIdFORM,ATIOW SEWER (check all that apply) WATER (check all that apply) SIDE SEWER REPAIR ❑ NEW WATER SERVICE INSTALLATION ❑ SIDE SEWER ALTERATION ❑ COMPLETE SERVICE ❑ METER ONLY ❑ NEW SIDE SEWER INSTALLATION SERVICE / NIETER 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: (circle desired size) ❑ I AM DECLINiNG MULTIPLE DOMESTIC WATER SERVICES FOR ❑ DOMESTIC: 3/4", 1", 2", OTHER: MY MULTI-FAMILY DEVELOPMENT UNDER SINGLE OWNERSHIP. ❑ �RRIGATION: 3/4", 1", 2", OTHER: ❑ I AM OPTING TO INSTALL MULTIPLE DOMESTIC WATER ❑ FIRE: 1", 2", 4", 6", 8", OTHER: SERVICES FOR MY MULTI-FAMILY DEVELOPMENT UNDER ❑ DOMESTIC/FIRE COMBO: 1", 2", OTHER: SINGLE OWNERSHIP. F/LL OUT REVERSE SIDE OF TH/S FORM. AGREEMENT.' The undersigned applicant agrees to comply wiih all provisions of the Everetf Municipal Code Title 94 Water and Seweror such ofher rules and regulafions now existing or which may be esfablished from time to time_ The applicant furfher agrees, as a condition precedent to receiving service that the utilities division shall have the right at any fime, without notice, to shuf o(f or turn on fl�e water supply for repairs, construcfion, and nonpayment of charges or for any other reasonable cause. I am fhe owner, or! am authorized by the owner of this property to perform the work r which appGcation is made, and l comply with the State Cont�actors Law 98.27 RCVl/a' 296.2 �WAC. / ,��,�v,_ ,�� _ �j -�-7- l -� Owner/Aufhorized Agent Signature Date Gity ot tverett Uftraai use vnry FEE i0� � �; - PERMIT # � (�'�'S'D�l (Revised 90/12/2015)