3618 OAKES AVE 2017-01-13 - Laserfiche WebLink

� `�.. � �� __ w��i��w�� uri�i��r��o��re�� CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 � FAX 42�-257-8857 �(E) everetteps@evereftwa.gov � www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: S� � � C�u,�s �� IF APPLICABLE: ❑ OUTSIDE CITY LIMITS ❑ BUILDING AREA SF ❑ LOT # BUILDING TYPE: E�"SFR-DETACHED ❑SFR-ATTACHED ❑DULEX ❑MULTI-FAMILY-# OF UNITS: ❑COMMERCIAL ❑INDUSTRIAL CHANGE OF USE? NO ❑ YES, FROM TO UTILITY APPLICATION INFORMATION SEWER (check all that apply) WATER (check all that apply) L8'S DE 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. ❑ 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. F1LL OUT REVERSE SIDE OF THIS FORM. CONTACT INFORMATION OWNER NAME: J/j/�'i� "-c y� " �h2,' �ti � 2 TENANT NAME (If Commercial): OWNER MAILWG ADDRESS: s�aEET (pi Gc � 6�� CITY �L�tl/'C �� STATE �yV r ZIP j j� OWNER PHONE: G�ZS Z/U QS �� OWNER EMAIL: _ , _ . ._.., ._ _. __ , . . .. _. . ._ ... _ _,.._ __ _ _ - _.._. _ __._ CONTRACTOR NAME: %%�c' !�D �LGYy� ' � �1 CONTRACTORADDRESS: srRee-r , `^ _S U 7/ `�"1.''� �L'�' � crrr G � ,�%% ^ � . � L�vi,� ziP � i � U STATE CONTRACTOR PHON : ZS - 7 7 - Z zS� �� CONTRAGTOR EMAIL: ��=. �� C: 5� `� �r: /lC, � L �r� �� , Cc� CONTRACTOR LIC. #(REQUIRED): /��%G L P� !' 3 L� CITY OF EVERETT BUSINESS LIC. #(REQUIRED): � _ _. __ . ___ . __ __ __. __. . PRIMARY CONTACT: ❑ OWNER � ONTRACTOR ❑ OTHER (Please Specify) �CO �'ACT NAME: CONTACT PHONE: �Z5 � ��7 - "z - _ Y'� CONTACT EMAIL: �(/ - J�-- AGREE ENT: The undersigned applicant agrees to comply with all provisions of the Everett Municrpa! Code Title City of Everett Otficial Use Only 14 Water and Sewer or such other rules and regulatrons now existing or which may be establfshed from time to time. The applicant further agrees, as a condition precedenf to receiving service fhat the utilities division shall have the right af any time, with t n e, to shut off or turn on the water supply for repairs, construction, and nonpaymenl of c es or r y other reasonable cause. 1 am the owner, or 1 am authorired by the owner of this property to p orm the w rk o whrch applicafion is made, and I comply with the State Contractors Law 1d,27 RCW and 96.200A�ii/ C. � , _ �z"-5_.� ��/(� Agent Signature Date FEE �O � PERMIT # u ��cZ — 003 (Revised 90/92/2015)