2531 RAINIER AVE 2022-05-11 - Laserfiche WebLink

� : �i _ �� �.,�r _ , �I:�� = 1.` _ : �� .I:�`�� `d�_ � ' �[ .�T�:�.C�7�TI 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 PROJEC"r SITE IWFORMATION PROJECT ADDRESS: �L�'' )� � {� IF APPLICABLE; ❑ OUTSIDE CITY LIMITS ❑ BUILDING AREA SF ❑ LOT # BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑DULEX ❑MULTI-FAMILY-# OF UNITS: ❑COMMERCIAL ❑INDUSTRfAL CHANGE OF USE? ❑ NO ❑ YES, FROM TO UTILITY APPLICATIOPI INFORMATIOioI 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 MUI_TIPLE DO�!�ESTIC WATER SERVIGES REC�UEST WATER SERVICE TYPF / S17_E (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. 14 Water and Sewer or such other �u/es and �egulations now exrsting or which may be esfablished from trme to time. The applicant fu�ther agrees, as a condition precedent fo receiving service that the ufilities division shall have the right at any time, without notice, to shut off or turn on the water supply for repairs, construcfion, and nonpayment of charges or for any other reasonable cause. I am the owner, or I am authorized by the owner of this property to perform fhe work for which application is made, and I comply with the State Confractors Law 18.27 RCW pnd 296.209A WAC. !' �, , I °;� : � �� '�y �.`� �%%:!��;�� ,.�� : �'� � � i� � �,�.� r 1 � Owner/Authorized Agent Signature FEE �' �'f�<�, � �-� PERMIT # � � ��1� �� (Revised 10/92/2015)