4202 TERRACE DR 2017-01-13 - Laserfiche WebLink

' . �� Q�� 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 PROJECT ADDRESS: IF APPLICABLE: BUILDING TYPE: CHANGE OF USE? PIiOJEC'1' SIT'E IPI�OF2MAl"IOEd -� .�. „ �. r-,_...._.s-- ❑ OUTSIDE CITY LIMITS ❑ BUILDING AREA SF ❑ LOT # �SFR-DETACHED ❑SFR-ATTACHED ❑DULEX ❑MULTI-FAMILY-# OF UNITS: ❑COMMERCIAL ❑INDUSTRIAL � NO ❑ YES FROM TO IDTILII'Y APPLICATIOIV 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: ❑ S1DE 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 OWNEftSHIP. ❑ �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. OWNER NAME: �! �}'� ' OWNER MAILING ADDRESS OWNER PHONE: CONTRACTOR NAME: � CONTRACTOR ADDRESS STREET � � L, e CITY ` 4;� r� '— l l� , . j r+' . -U �w r C�_ L-i�� :'� srRetr ;� i G � CONTACT INFORMATION TENANT NAME (If Commercial): �OWNER EMAIL: y�' � +�.:.._ �=�- `--~� �z�� � � i``;, e� �� i`3. A, STATE �� , ZIP ,�""' - .�e� ;;,� L%�� STATE ��'. �� - �.�� G -' r' ,t�� , l 's CITY : �. `� CONTRACTOR PHONE: �°�1�"�� <�� -s'�� r CONTRAC70R EMAIL: �� .f'�� ! �'i��.c.�.�.%� `-'' ' - � "�C�' -"'-� �� "`� CITY OF EVERETT BUSINESS LIC. #(RE CONTRACTOR LIC. #(REQUIRED): ,' ;`L` _ .�.-- �� t ) �.1 �'ti 1--- PRIMARY CONTACT: ❑ OWNER CONTRACTOR ❑ OTHER (Please Specify) CONTACT NAM�:.` ,_ CONTACT PHONE: �� - �'�,� � '�? s-� � — " '� C �j, ir-� --� / �l (� � CONTACT EMAIL: l� t�` 1C� i �r1 I` C�.{ "' :Ci =/4-`� AGREEMEfVT The.undersigned applicant ag�ees to comply with aI! provrsions of the Everett Municipal Code Tit/e �C�tY of E ! d re ulations now existing or which may be established frorn time to FEE Officia/ Use Onfy 14 Water and Sewer or such other ru es an g � fime. The applicanf further agrees, as a condition precedent to receiving service that the utilities division shall have /� the right af any time, without notice, to shut off or turn on fhe water supply for �epairs, construction, and nonpayment of charges or fo� any ofher reasonable cause. I am the owner, or t am autliorized by the owner of this properfy to perform fhe work for �uhi plication is made, and I comply with the State Confractors Law 18.27 pF �T #�� r�� _R RCW and ?96.?OOA WAE. .' � r ;l _ �� _ � `� �1 �_ �. . �. � '�' ' ,� OwnerlAutho ze . A' ent Signature Date (Revised i0/12/7015)