1911 78TH PL SE 2017-06-29 - Laserfiche WebLink

VI/�: � �R / SEVUER UTILITY � �� PLICATION CITY OF EVERET7 PERMiT SERV(CES 3200 CEDAR STR�ET, EVERETT, WA 98201 (P)425-257-8810 � FAX 425-257-8857 ( (E) everetteps�a everettwa.gov � www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECTADUI7ESS: 1911- 78TH PL SE EVERETT WA 98204 IF APPLICABLE: ❑ OUTSIDE CIT`(LIMITS ❑ BUILDING AREA 2435 �F ❑ LOT# 15 Bl1tLDING TYPE: �S�R ❑ MULTI-FAMIL.Y ❑GOMMERGIAL ❑ INaUSTRIAL CtiA[UGE OF USE? �� ❑YES, FROM TO UTILlTY APPLICATIaN INF�RMATION SEWER (check all that apply) WATER(check all that apply) ❑ SIDE SEWER REPA(R �NEW WATER SERVICE INSTALLATION �SlDE SEWER ALTERAT(ON ❑ C(�MPLETE SERVICE � METER�NLY � NEW SIDE SEWER INSTALLATlON SERVICE!METER USE: C]1NSTALL BACKWATER VALVE(outside the building) �SFR ❑SIDE SEWER CAP-OFF ❑ MULTI-FAMILY-#OF UNITS: � SIDE SEWER RECONNECTION ❑ COMMERClAL � MULTIPLE DOMESTIC WATER SERVICES REQUEST WATER SERVICE TYPE!SIZE: (circle desired size} ❑I AM QECLINING MULT(PLE UOMESTIC WATER SERVICES F�R ❑ DOMESTIC: 314", 1", 2", OTHER: MY MU[.TI-FAMILY DEVELOPMENT UNbER SINGLE OWNERSHIP. ❑ ��RIGATfON: 314", 9", 2", OTNER: � I AM OPTING TO INSTALL MULT[PLE QOMESTIC WA7ER ❑ FIRE: 1", 2", 4^, 6", 8", pTHER: SERVIC�S FOR MY MULTI-�AM!!.Y DEVELOPMENT UNDER �] ppMESTEClF1RE COMBO: 1"1 2", OTHER: SINGLE OWNERSHiP. FlLL OUT REVLRSE SIb,E OF THIS FORM. CONTACT INFORMATION OWNER NAME:ALPINE HEIGHTS LLC TENANT NAME(If Commercial): OWNER MA{LING ADDRESS: s�uEET 120 SW EVERETT MALL WAY SUITE 100 cirr EVERETT S�-A-� WA Z�P 98204 OWHERPHONE: 360-953-2800 OWNEFlEMAiL: WWW.SEAPACHOMES.COM CONTRACTaR NAME: SEA PAC HOMES CONTRACTqR ADDRESS: srneeT 120 SW EVERETTT MALL WAY SUITE 100 crrv EVERETT srATe wA ziP 98204 CONTRACTOR PHONE 3 6 0-95 3-2 S 0 0 CONTRACTOR EMAlL: WWW.SEAPACHOMES.COM CONTRAGTOR LICENSE#(REQl11RED): CITY OF EVERETT BUSINESS LICENSE#(REpUIRED): _ _ _.. _. ,. . _. _.. _ PRIMARY GONTAC'i": ❑OWNER �CONTRACTOR ❑OTNER(Please Specify) __ GONTACTNAME: STEVE SNYDER CONTAC7PFlONE:425-319-0122 CONTACT EMAtL: STEVE.S@SEAPACHOMES.COM AGREEMENT:The undersigned app/icant agrees fo comply with a7t provisions of the Everetf Municrpal Code 7itle City of Everett O�Crat Use Only 44 VJaterand Sewer or s�rch othar rules and�eguJations now exisfing or which may be es2abiished from time to FEE time. 7he app/icant(urther agrees,as a condifion preceo'en[to receiving service ihat the ufitrties division shaJl have the right ai any fime,withoUt notice,fn shut off or tu�n on ihe wafer supplj�far repairs,cansiruction,and nonpayme of charge or for any other reasonable cause.1 am the owner,or 1 am auttaonzed by fhe owner or this pmparty to edorm t ork for which application is made,and!cumply u�ith the State Contractors Law 48.27 pERMIi'# �^ RCW a d 9B. OOA . r � h . 3-4-16 U � �PG � �V "l'�� OwnerlAuthori�ed Ag t SignaLure Date (Revised 09i2b/20i5j / ''