234 HEATHER RD 2017-01-13 - Laserfiche WebLink

(P) 425-257-8810 `��,�T�R :��'ti��,��R U � iLITY ��'� iC��`G� CiTY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 FAX 425-257-8857 �(E) everetteps@everettwa.gov � www.everetiwa.gov/permits �'ROJECi' Sli'E 1�9�ORMA7°'IOfV PROJECT ADDRESS• � 3`'� H Ll�i� L�� <L'�l IF APPLICABLE: ❑ OUTSIDE CITY LIMITS ❑ BUILDING AREA SF ❑ LOT # BUILDING TYPE: ❑SFR-DETACHED -�SFR-ATTACHED ❑DULEX ❑MULTI-FAMILY-# OF UNITS: ❑COMMERCIAL ❑INDUSTRIAL CHANGE OF USE? ❑ NO ❑ YES, FROM TO � IJi1LITY �►PPLICATIOM IIdFORMATIOW SEWER (check all that apply) WATER (check all that apply) [�l SIDE SEWER REPAIR ❑ NEW WATER SERVICE INSTALLATION ❑ SIDE SEWER ALTERATION ❑ COMPLETE SERVICE ❑ METER ONLY ❑ NEW SIDE SEWER INSTALLATION SERVICE / METER USE: ❑ INSTALL BACKWATER VALVE (outside the bui�ding) ❑ SFR ❑ SIDE SEWER CAP-OFF ❑ MULTI-FAMILY-# OF UNITS: ❑ SIDE SEWER RECONNECTION ❑ COMMERCIAL MULTIPLE DOMESTIC WATER SERVICES REQUES7 WATER SERVICE 7YPE / 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 ❑ DOMESTIClFIRE COMBO: 1", 2", OTHER: SINGLE OWNERSHIP. FILL OUT REVERSE SIDE OF THIS FORM. AGREEMENT: The undersigned applicant agrees to comp/y witn an prov�sions or rne cvereu ,��n��Nd� ��uc ��«� 94 Wafer and Sewer or such other n�les and regulations now exisfing or which may be established from fime 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 shuf off or tum on the water supp/y forrepairs, consfrucfion, and nonpayment of charges or for any other reasonable cause. 1 am the owner, or l am authorized by the owner of this prope�ty to perform the work for which application is made, and 1 comply with the State Cont�actors Law 98.27 RCW and 29620� WfSE. , n ignature L � ' Date v.ay vi �.�w�.�. ...�,....... ...... ., FEE PERMIT # � � (Revised 90/92/2095)