1819 CEDAR ST 2017-01-13 - Laserfiche WebLink

� � r� L � WATER / SEWER llT1LITY APPLICATION CITY 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 SITE INFORMATION PRo�ECT Ao�Ress: 1819 Cedar Street IF APPLICABLE: ❑ OUTSIDE CITY LIMITS ❑ BUILDING AREA SF ❑ LOT # 00531300201000 BUILDING TYPE: P�SFR-DETACHED ❑SFR-ATTACHED ❑DULEX ❑MULTI-FAMILY-# OF UNITS: ❑COMMERCIAL ❑INDUSTRfAL CHANGE OF USE? � N� ❑ YES, FROM TO UTILITY APPLICATION INfORMATION SEWER (check al( that apply) WATER (check all that apply) QI SIDE SEWER REPAfR � NEW WATER SERVICE INSTALLATION ❑ SIDE SEWER ALTERATION ❑ COMPLETE SERVICE ❑ METER ONLY ❑ NEW SIDE SEWER INSTALLATION SERVICE / METER USE: ❑ INSTALL BACKWATER VALVE (outside the building) ❑ 5FR ❑ SIDE SEWER CAP-OFF ❑ MULTI-FAMILY -# OF UNITS, ❑ SIDE SEWER RECONNECTION ❑ COMMERCIRL 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 DOME5TIC WATER ❑ FIRE: 1", 2", 4", 6", 8", OTHER: SERVICES FOR MY MULTI-FAMILY DEVELOPMENT UNDER ❑ DOMESTIC/FIRE COMBO: 1", 2", OTHER: SINGLE OWNERSHIP. FILL OUT REVERSE SIDE OF THIS FORM. CONTACT INFORMATION OWNER NAME: KIt11b@CIy PBYfIe TENANT NAME (If Commercial): OWNER MAILING ADDRESS: sTREEr 1819 Cedar Street �,n Everett STATE WA z�P 98201 OWNER PHQNE: 425-25Z-S379 OWNER EMAIL. I(1171p8YC1@66 mail.com CONTRACTOR NAME: SpOSBfI IC1C, dba Mr. Rooter Plumbing & Heating CONTRACTORADDRESS: srReer2000 South 116th Street �,n Seattle STATE WA Z,P 98168 CONTRACTOR PHONE: 2O6-F15'I-29� 7 CONTRACTOR EMAIL: Ci18t'I@neI@CTII't"OOt@rSBa.COC1'1 co�r�acrc�� ic. #��ou�R�a�: MRROOP*022NE CITY OF EVERETT BUSINESS LIC. #{f�Et�llIREO): O3SO8O PRIMARY CONTACT: ❑ OWNER (a CONTRACTOR ❑ OTHER (Please Specify) __ CONTACT NAME: CONTACT PHONE:2�6-65�-29� 7 Charlene Lundgren coNSACT �MA��: charlenel@mrrootersea.com AGREEMENT: The undersigned applicant agrees to comply with all provisions of fhe Everett Municipal Code Title 14 Water and Sewer or such other rules and regulations now existing or which may be eslab/ished /rom time to time. The applicant fuRher agrees, as a condition precedent to receiving service lhat the utilrties division shall have the nghf at any time, withouf notice, fo shut off or turn on the water supply for repairs, construcfion, and nonpayment of charges or for any other reasonable cause. 1 am the owner, or l am authorized by the owner oi this property to periorm fhe work for which application is made, and I comply with the State Contractors !aw 18.27 RCW and 296.200A WAC, �; City ol Everett O(ficial Use Onty �Y� PERMIT # � �' j � � � � � � �� .� ��-�� .� . �� 023 n lAuthor�zed Agent Si ature� Date (Revised 9/23/2016)