1829 OAKES AVE 2017-01-13 - Laserfiche WebLink

w��s�w�� u�iLi�rY�►��oc��ioN 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 UTILITY APPLICATION INFORMATION 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 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. FILL OUT REVERSE SIDE OF THIS FORM. CONTACT INFORMATION OWNER NAME: v i��. ��au� So "� TENANT NAME (If Commercial): OWNER MAILING ADDRESS: srREET `� Z� (��c5 L CITY V{,�G �+ - STATE �/"r ZIP { 7! ZO I OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: �c��WG6 ��,v�b� CONTRACTOR ADDRESS: srReer Z�U � S� �.e-6 S#' CITY ,�CG�I ` ►�'t— STATE {,�� ZIP � � �CI �O CONTRACTOR PHONE: ZO(p -`�3Z.' I1l�j CONTRACTOR EMAIL: CONTRACTOR LIC. #(REQUIRED): SC�uTHtaPQS� lG (o CITY OF EVERETT BUSINESS LIC. #(REQUIRED): U�103U PRIMARY CONTACT: ❑ OWNER ONTRACTOR ❑ OTHER (Please Specify) CONTACT NAME: CONTACT PHONE: ?L�C. ��-{�L� • y�-t,g0 � � � �j�,�; S CONTACT EMAIL: AGREEMENT: The undersigned applicanf agrees to comply wifh all provisions of the Everett Municipal Code Title 14 Water and Sewer or such other rules and iegulations now existing or which may be esiablished from time to trme. The applicant further agrees, as a co ition precedent to receiving service that the ' ities division shall have the righf at any time, without notice shut o� tu�n o fer upply for repai , co sfruction, and nonpayment of charges or for other r sonabl au . th o ner, or 1 horized by fhe owner of this property to perform the wor or v✓hich plicat i , a it h tate Contract � Law 1�27 RCW and 29fi200A WA . _ s �f�zs'��c, uthorized City of Everetf Offrcial Use Only FEE f�� ��0 ;�r / PERMIT # U I �6� 0�1 � (Revised 10/12/2015)