1506 38TH ST 2022-05-19 - Laserfiche WebLink

WATER / SEWER UTILITY APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 I FAX 425-257-8857 I (E) everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE;INFO, PROJECT ADDRESS: 19b Co 1)(64U gr. IF APPLICABLE: 0 OUTSIDE CITY LIMITS 0 BUILDING AREA SF 0 LOT# BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑DULEX 0 MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL 0 INDUSTRIAL CHANGE OF USE? X.N.2 0 YES, FROM TO UTILITY APPLICATION INFORMATION SEWER(check all that apply) WATER(checkall that apply) ❑SIDE SEWER REPAIR 0 NEW WATER SERVICE INSTALLATION ❑SIDE SEWER ALTERATION 0 COMPLETE SERVICE 0 METER ONLY ❑ NEW SIDE SEWER INSTALLATION SERVICE/METER USE: VLINSTALL BACKWATER VALVE(outside the building) 0 SFR ❑SIDE SEWER CAP-OFF 0 MULTI-FAMILY-#OF UNITS: ❑ SIDE SEWER RECONNECTION 0 COMMERCIAL MULTIPLE DOMESTIC WATER SERVICES REQUEST WATER SERVICE TYPE/SIZE: (circle desired size) ❑ I AM DECLINING MULTIPLE DOMESTIC WATER SERVICES FOR 0 DOMESTIC: 3/4", 1", 2", OTHER: MY MULTI-FAMILY DEVELOPMENT UNDER SINGLE OWNERSHIP. 0 IRRIGATION: 3/4", 1", 2", OTHER: ❑ I AM OPTING TO INSTALL MULTIPLE DOMESTIC WATER 0 FIRE: 1", 2", 4", 6", 8", OTHER: SERVICES FOR MY MULTI-FAMILY DEVELOPMENT UNDER 0 DOMESTIC/FIRE COMBO: 1", 2", OTHER: SINGLE OWNERSHIP. FILL OUT REVERSE SIDE OF THIS FORM. c ` / I CONTACT INFORMATION OWNER NAME: V b Rh-11/1,m,� J (.1 1 m iukji TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET CITY STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: A° " hat* CONTRACTOR ADDRESS: STREET 1 y �e(/lr weft CITY STATE Wel • ZIP ateitS �} CONTRACTOR PHONE: 21 ®123 CO TRACTOR EMAIL: �..''II ! t OtaMai I I COM CITY OF EVERETT BUSIN� LIC #(REQUIRED))) CONTRACTOR LIC #REQUIRED ,, ,5.1,. PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) r-- CONTACT NAME:• , CONTACT PHONE: (../146A.)ci/b 9Z1 6 Y 9 16 v4 1 1rit. 1 CONTACT EMAIL: /� ( ;l4 I l I� " "� ecowi AGREEMENT:The undersigned applicant agrees to comply with all provisions of the Everett Municipalld.de Title City of Evert Official Use Only 14 Water and Sewer or such other rules and regulations now existing or which may be established from time to FEE time. The applicant further agrees, . a con I. precedent to receiving service that the utilities division shall have CD the right at any - e,w. . t notic ,to shut off o turn on the water supply for repairs,construction,and s nonpayment ch r.-s or or an other reasona le cause.I am the owner,or I am authorized by the owner of this property top or he wo • hich applicatio is made,and I comply with the Contractors Lacy 18.27 PER MI #� RCW and 29 200 WAC '' ! (16\ -\(�j ,r0[0 Il / (Revised 10/12/2015) Owner/Authoriz•.` ,•gent Sig,ature Date