1913 78TH PL SE 2017-06-29 - Laserfiche WebLink

W� �R 1 SEWER UTILITY / PLIGATiON CiTY OF EVEREI"7 PERMIT SERVECES 320Q CEDAR ST�REET, EVERETT, WA 982a1 (P)425-257-8810 � FAX 425-257-8857 � (E)everetteps@everettwa.gov f wuiw.evereriwa.gov/permits PROJECT SITE INFt3RMAT10N PROJECTADDFZESS: 1913- 78TH PL SE EVERETT WA 98204 IF APPLICABLE: ❑ OUTSIDE CITY LIM17S ❑ BUILDING AREA 1816 SF ❑ LOT# 14 BUtLDING TYPE: � SFR ❑ MULTI-FAMII.Y ❑ COMMERCIAL ❑ INDUSTRiAL CHANGE OF USE? ��Q ❑YES, FROM TO UTILlTY APPLICATION INFORMATION SEWER (check ail that apply) WATER(check all#htat apply) ❑SIQE SEWER REPAIR � NEW WATER SERVICE WSTALLATIdN ❑StDE SEWER ALTERATION ❑ COMPLETE SERVICE � MEl'ER ONLY � NEW SIDE SEWER INSTAL�A710N SERVICE/METER USE: ❑ INS7ALL BACKWATER VALVE(outside the building) �SFR ❑SIDE SEWER CAP-OFF ❑ MULT(-FAMILY-#dF UM7S: ❑ SIDE SEWER RECONNECTIaN � COMMERClAL MULTIPLE DOMESTIC WATER S�RVICES REQUEST WATER SERVECE TYPE/SIZE:(circle desired size) ❑i AM DECLINING MULTfPLE QOMESTIC WATER SERVICES FOR Q DOMESTIC: 3/4", 1", 2", (77HER: MY MULTI-FAMILY DEVELOPMENT UNDER SINGLE OWNERSHIP. ❑ IRRIGATION: 3/4", 1", 2", OTHER: ❑ I AM OPTING TO INSTALL MULTfPLE DOMESTIC WATER ❑ FIRE: 1", 2", 4", 6", 8", OTHER: SERVICES FOR MY MULTI-FAMI�Y DEVELOPMENT UNDER jg]ppMESTfC/F1RE COMBO: 1� 2", OTHER: SINCLE OWNEf2SHIP. FlLL OUT REVERSE SID,E OF THiS FORM. CONTACT INFORMATION OWNER NAME:ALPINE HEIGHTS LLC TENANT NAME(If Commerciai): OWNERMAILINGADDRESS: sTrtEET 120 SW EVERETT MALL WAY SUITE 100 cirr EVERETT sTAtE WA ziP 98204 OWNER PHONE: 360-953-2800 OWNER EMAlL: WWW.SEAPACHOMES.COM CONTRACTOR NAME: SEA PAC HOMES COiVTRACTOi2 ADDRESS: s��ET 120 SW EVERETTT MALL WAY SUITE 100 crrv EVERETT s;a�e wA ziP 98204 CONTRACTORPHONE 360-953-2800 CQNTEtACTOF2EMAiL: WWW.SEAPACHOMES.COM CONTF2ACTOR LICENSE#{REc�UiRED): CtTY OF EVERETT BUSINESS LICENSE�f(REqu�RED}: _ ___ . PRtMARY GON7ACT: ❑OWNER �CONTRACTOR ❑OTHER(Please Specify) ___ _ _ CONTAC7 NAME: STEVE SNYDER CONTACT PHONE:42 5-319-0122 CONTACT EMAIL: STEVE.S@SEAPACHOMES.COM AGRFEMElYT The uncleisigned app/icanf agrees to comply wrth al!provisions of the Everett Municrpa!Code T"dle City of Everett UKcia!Use Only 1�Waterand Sewer or such othe�rules and regulations now existing or which may be es1�blished from time(o FEE time. 7he applicant turtheragrees,as a condition precedent to receiving servtce[hat the u!ilities c�ivision shall have the right at any time,without nofice, fa shut offorturn on ihe waterszppiy lorrepairs,constrr�ction,and nonpayme of charge or for any other reasonabte cause.f an,the owner,or J am aufhorized by the owner oi this property t edorm Sh ork for which application is made,and!comply with!he State Contractors Law 98.27 PERMI # R�W a d 96. OOA . 3-4-16 � �� -C� 1, l OwnerlAuthorized Ag t SEgnature Date (Revised 09i25/20i5j � J�Fr