2015 78TH PL SE 2017-03-16 - Laserfiche WebLink

WR ! SEWER UTILITY _ PLICATION ,£.$ETTCITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@everettwa.gov www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 2015 - 78TH PL SE IF APPLICABLE: 0 OUTSIDE CITY LIMITS 0 BUILDING AREA 2435 SF ❑ LOT# 1 BUILDING TYPE: El SFR 0 MULTI-FAMILY 0 COMMERCIAL ❑ INDUSTRIAL CHANGE OF USE? X=I NO ❑YES, FROM TO UTILITY APPLICATION INFORMATION SEWER (check all that apply) WATER(check all that apply) ❑ SIDE SEWER REPAIR El NEW WATER SERVICE INSTALLATION ❑SIDE SEWER ALTERATION ❑COMPLETE SERVICE El METER ONLY Ki NEW SIDE SEWER INSTALLATION SERVICE/METER USE: ❑INSTALL BACKWATER VALVE(outside the building) USER ❑SIDE SEWER CAP-OFF ❑ 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 ❑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 El DOMESTIC/FIRE COMBO: 2", OTHER: SINGLE OWNERSHIP. FILL OUT REVERSE SIDE OF THIS FORM. CONTACT INFORMATION OWNER NAME:ALPINE HEIGHTS LLC TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET 120 SW EVERETT MALL WAY SUITE 100 crre EVERETT STATE WA zip 98204 OWNER PHONE: 360-953-2800 OWNER EMAIL: WWW.SEAPACHOMES.COM CONTRACTOR NAME: SEA PAC HOMES CONTRACTOR ADDRESS: STREET 120 SW EVERETTT MALL WAY SUITE 100 crrY EVERETT STATE WA ZIP 98204 CONTRACTOR PHONE 360-953-2800 CONTRACTOR EMAIL: WWW.SEAPACHOMES.COM CONTRACTOR LICENSE#{REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: ❑OWNER M CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: STEVE SNYDER CONTACT PHONE:425-319-0122 CONTACT EMAIL: STEVE.S@SEAPACHOMES.COM AGREEMENT:The undersigned applicant agrees to comply with all provisions of the Everett Municipal Code Title City of Everett 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,as a condition precedent to receiving service that 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 nonpayme of charge or for any other reasonable cause.lam the owner,or tam authorized by the owner of this property t.1.•rform ih:c.rk for which application is made,and f comply with the State Contractors Law 18.27 PERMIT# RCWa d 96. '00A / U o) 1 3-4-16 (it (C 0 �Op2S Owner/Authorized Ag: t Signature Date (Revised 00125/2015f