2507 FULTON ST 2022-04-15 - Laserfiche WebLink

�:. � �� _ 1ll,, �, ,l - 1 � 'V' - � �� - �" ``� , f ,_� 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 PIZAJEC'1' SITE IPIFORMI�TION PROJECT ADDRESS: �A� � �,� ; � �� +l IF APPLICABLE: ❑ OUTSIDE CITY LIMITS ❑ BUILDING AREA SF ❑ LOT # BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑DULEX ❑MULTI-FAMILY-# OF UNITS: ❑COMMERCIAL ❑INDUSTRIAL CHANGE OF USE? ❑ NO ❑ YES, FROM TO UTILITY APPLICATION INFORMATIOhI 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 51DE SEWER INSTALLATION SERVICE / METER USE: � INSTALL BACKWATER VALVE (outside the building) ❑ SFR ❑ SIDE SEWER CAP-OFF ❑ MULTI-FAMILY -# OF UNITS: ❑ SIDE SEWER RECONNECTION ❑ COMMERCIAL MU[_TIPLE DOI�IIF_S�IC 4MAT�R SERVICES REG?U�ST WATFR SFRVICF TYPF / S17F: (circle desired size) ❑ I AM DECLINING MULTIPLE DOMESTIC WATER SERVICES FOR ❑ DOMESTIC: 314", 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. 94 Water and Sev✓er or such oiher rules and regulatians now exisfing or which may be establisf�ed fiom time to time. The applicant further agrees, as a condition precedent to receiving service that fhe utilities division shall have the right at any fime, without notice, fo shut off or turn on the water supply fo��epai�s, construction, and nonpayment of charges or for any other reasonable cause. l am fhe owner, or l am authorized by the owner of thrs property to perform the wo�k for which application is made, and,l comply with the State Contracfors Law 98.27 RCW nd 296.209A WAC. ` � 1 j I� l , �l `'�'I 1 � °-? I/� �' � � !� /i��%�. � �'; r `t� I � � �i� ` � .N Agent Signature FEE -� �'��',�`�i PERMIT # � j l�C�-�� (Revrsed 10/92/2015)