1007 HOYT AVE 2017-01-13 - Laserfiche WebLink

� @�9'��'��'3 / ��9�� L�➢`�� '��q��9��1 � CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 � FAX 425-257-88�7 �(E) everetteps@everettwa.gov � www.everettwa.govlpermits PROJEC'i' S11'E I�FOEttldlA'i°I�IF� PROJEGTADDRESS: 1 OC� 7 �'��rt �) //r' IF APPLICABLE; ❑ OUTSIDE CITY LIMITS ❑ BUILDING BUILDING TYPE: OF USE? SF ❑ LOT #. ❑SFR-DETACHED OS`FR ATTACHED ❑DULEX ❑MULTI-FAMILY-# OF UNITS: ❑COMMERCIAL ❑1NDUSTRIAL (��.' �f�1D ❑ YES, FROM TO aJl'1LIl'Y APPLiCd►TIORI IIdFORMA'i'IOW 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: ❑ INSTALL BACKWATER VALVE outside the building) ❑ SFR ❑ SIDE SEWER CAP-OFF ❑ MULTI-FAMILY-# OF UNITS: ❑ SIDE SEWER RECONNECTION ❑ COMMERCIAL MULTIPLE D�MESTIC 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. ❑ 1RRIGATION: 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 THIS FORM. AGREEMENT.� The undersigned applicant agrees to comply with all provisions of the Everetf Municipal Code Title 14 Water and Sewer or such other rules and regulations now existing or which may be esfablished from fime to time_ The applicant further agrees, as a condition precedent to receiving service that the utilities division shall have fhe right at any fime, without notice, to shut ofF or turn on the watersupply for repairs, construction, and nonpayment of charges or for any other reasonable cause. I am fhe owner, or 1 am authorized by tl�e owner of this property to perform the work for which application is made, and 1 comply with the State Contractors Law 1II.27 RCW and 296200R WAC. '� �`___ _ n,..�J_� __ S�— z � � _ �- �,� Owner/Authorized Agent Signature Date Crty ot �verett Utt�c�a� use vnry FEE � ��.� PERMIT # 4 � �� .��f (Revised 90/12/2095)