1310 MAPLE ST 2017-01-13 - Laserfiche WebLink

(P) 425-257-8810 �` ,,:� -� �— "� �� " - 1 � r� '^ � � �' CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 FAX 425-257-8857 �(E) everetteps@everettwa.gov � www.everettwa.govlpermits PROJEC"r SITE IPIFORMATION PROJECT ADDRESS: ��'1 , � 1 IF APPLICABLE: ❑ OUTSIDE CITY LI ITS ❑ 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 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: ❑ 51DE SEWER RECONNECTION ❑ COMMERCIAL l�UI_TIPLE bO�AESTIC �JI(ATER SFR\/ICES RF_G?UES?' WATFR SFRVICF_ TYPF / S17_E: (circle desired size) r--- — -- --------- ❑ 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. 14 Water and Sewer or such oiher �ules and regulations now exrsting or which may be esiablished from time to time. The applicant fu�ther agrees, as a condition precedent fo receiving service fhat the utilities division shall have the right at any time, without notice, to shut off or turn on the water supply for repairs, consfruction, and nonpayment of charges or for any other reasonable cause. l am the owner, or l am authorized by the owner of thrs prope�fy to peiform the wo�k for which application is made, and I comply with the State Contractors Law 98.27 RCW �nd 296.20l�A WAC. ' � � �, 1 e ! A ;i,, �--� /a ��f�.��r i, ,�r.,a �`�� ;��1.�: ° �� 1:, g �� . v i :, Agent Signature FEE ! '�'✓��s'�`r' PERMIT # � �' �Y ,�`°�j � � � � (Revised 90/12/2095)