1024 GRAND AVE 2017-01-13 - Laserfiche WebLink

� � 1nlA��i� / S�IIV�� I�I`�� A��I�e�iION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 � FAX 425-257-8857 �(E) everefteps@everettwa.gov � www.everettwa.gov/permits PROJECT ADDRESS: IF APPLICABLE: BUILDING TYPE: CHANGE OF USE? PROJECT SITE INFORMA'f10N VL 1 v ❑ OUTSIDE ITY LIMITS ❑ BUILDING AREA SF ❑SFR-DETACHED ❑SFR-ATTACHED ❑DULEX ❑MULTI-FAMILY-#OFUNITS: �NO ❑ YES, FROM TO ❑ LOT # ❑COMMERCIAL ❑INDUSTRIAL UTILITY APPLICATIOI+1 INFORIVIATIOId 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 / METER USE: '�] � NSTALL BACKWATER VALVE (outside fhe 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. ❑ IRRIGATION: 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. FILL OUT REVERSE SIDE OF THIS FORM. H(�KttMtNl: ine uuuera�y��c� of.N��o�,. �y .................N., ...... -�- ��------- -- --� . 94 Water and Sewer or such other rules and regulations now existing or which may be established from time to time. The applicant further agrees, a con i n precedeni to receiving service that the uiilities division shall have the righf at any ' e, w' f notic , to shut off o turn on the water supp/y for repairs, construction, and nonpayment f ch r s or or an other reasona le cause. I am fhe owner, or 1 am authorized by the owner of this property to p or he wo hich applicatio is made, and / comply with the State Contraciors Law 98.27 RCW and 29 200 WAC �� 1 �� wnerlAuthoriz gent Sig ature Date FEE � �.�� PERMIT # � i � I I -� 6C� � (Revised 10/12/2015)