2101 WETMORE AVE 2017-01-13 - Laserfiche WebLink

� �_ WATER / SEWER UTILITY APPLICATION 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 SITE INFORMATION PROJECT ADDRESS: 2� O� I 2� O3 WGt�7101"e AVE, Everett, WA 98201 IF APPLICABLE: ❑ OUTSI�E CITY LIMITS ❑ BUILDING AREA SF ❑ LOT # BUILDING TYPE: ❑SFR-DETACHED OSFR-ATTACHED ❑DULEX ❑MULTI-FAMILY-# OF UNITS: ❑COMMERCIAL ❑INDUSTRIAL CHANGE OF USE? 0 N� ❑ YES, FROM TO 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. ❑ 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. FILL OUT REVERSE SIDE OF THIS FORM. CONTACT INFORMATION OWNER NAME:Barbara Lamoureux TENANT NAME (If Commercial): OWNER MAILING ADDRESS: srHEer1904 Wetmore Ave �„Y Everett STATE WA „P 98201 oWNER PHONE: 425-356-7975 OWNER EMAIL: barb@lamoureuxhome.com CONTRACTOR NAME: Bodine CONTRACTOR ADDRESS: sTkeer6009 212th st sw �,rv Lynnwood STATE WA Z,P 98036 CONTRACTOR PHONE: 425-778-2557 CONTRACTOR EMAIL: 111f0 U�BOdifl2COnStCUCtIOn.00171 CONTRACTOR LIC. #(REQUIRED): BODINC*332BT CITY OF EVERETT BUSINESS LIC. #(REQUIRED):053924 PRIMARY CONTACT: ❑ OWNER 0 CONTRACTOR ❑ OTHER (Please Specify) CONTACT NAME: C 1 1 U C f\ RG � d CONTACT PHONE: 206-510-6394 CONTACT EMAIL: chuck@bodineconstruction.com AGREEMENT: The undersigned applicant agrees to comply with all provisions of the Everett Municipal Code 1 itle 14 Water and Sewer or such ofher rules and regulations now existing or which may be established from time to time. The applicanf further agrees, as a condition precedent to receiving service thaf the utilities division shall have the right at any time, without notice, to shut off or turn on the water supply for repairs, construction, and nonpayment of charges or for any oiher reasonable cause. 1 am ihe owner, or I am authorized by the owner of this property to perform the work for which application is made, and 1 comply with the State Contractors Law 18.27 RC� 296.200A WAG ��J/Ji/l �/�r ��ti horized Agent Signature Date City of Everett Official lJse Only FEE � �O vJ PERMIT # � t � o�-ooa (Revised 10/12/2015)