1915 78TH PL SE 2017-06-29 - Laserfiche WebLink

1N� ER I SEWER UTILITY ; 'PLICATION GTY OF EVERETT PERMIT SERVECES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 � FAX 425-257-8857 � (E) everetteps@everet#wa.gov ( www.everettwa.govlpermits PROJECT SITE INF�RMATION PROJECTAQi7RESS: 1915- 78TH PL SE EVERETT WA 98204 IF APPLECABLE: ❑ �UTSIDE CITY LIMITS ❑ BUILDING AREA 1816 SF ❑ LpT# 13 BUILDING TYPE: �SFR ❑ MULTI-FAMI�Y ❑ GOMMERCIAL � INQUSTRIAI. CHANGE OF USE? �� ❑YES, Ff20M Tp UTILITY APPLICATION INFORMATION SEWER (check all that apply) WATER(check all that apply) ❑ SIDE SEWER REPAIR �NEW WATER SERVICE(NSTALLATION ❑SlDE SFWER ALTERATfON ❑GOMPLETE SERVICE � METER ONLY � NEW SIDE SEWER INSTALLATION SERVICE/METER USE: Cl fNSTALL BACKWATER VALVE outside the buiiding) �SFR ❑SIDE SEWER CAP-OFF ❑ MULTI-FAMILY-#dF UNlTS: ❑ S[DE SEWER RECONNEC710N �COMMERCIAL MULTIPLE DOMESTIC WATER SERVICES REQUEST WATER SERVECE TYPE!SIZE: (circle desired size) ❑f AM DECLINING MULTfPLE QOMESTIC WATER SERVICES FOR ❑DdMESTIC: 3/4", 1", 2", OTHER: MY MULTI-FAMILY DEVELOPMENT UNDER SIfVGLE OWNERSHIP. ❑ IRRfGATION: 3J4", 1", 2", OTNER: ❑ I AM OPTING TO INSTALL MULTfPLE DOMESTIC WATEf2 ❑ FIRE: 1", 2", 4", 6", 8", OTHER: SERVICES FOR MY MULTI-FAMILY DEVELOPMENT UNDER g] pOMESTEClF1RE COMBO: �',) 2", OTHER: SINGLE OWNERSHlP. FiLL OUT REVFRSE SID,E OF TH1S FOIZM. L� CONTACT INFORMATION OWNER NAME_ALPINE HEIGHTS LLC TENANT NAME(If Commercial): OWNER MAILING ADDRESS: srH�eT 120 SW EVERETT MALL WAY SUITE 100 cirr EVERETT sTA7E WA �iP 98204 OWNERPHONE: 360-953-2800 OWNEFtEMAiL: WWW.SEAPACHOMES.COM CONTRACTOR NAME: SEA PAC HOMES C0�1T(2ACTOF2 ADDRESS: s�u�ET 120 SW EVERETTT MALL WAY SUITE 100 crrv EVERETT Sr,�-� WA ziP 98204 CONTRACTOR PHONE 3 6 0-95 3-2 8 0 0 C�NTRACTOR EMA1L: WWW.SEAPACHOMES.COM CONTRAGTOR LICENSE#(REQUIREU): CtTY OF EVERETT BUSINESS UCENSE#(REQUIRED}: _ _. .. PRIMARY GONTACT: ❑OWNER �CONTRACTOR ❑OTHER(Pisase Specify)_ CONTACT NAME: STEVE SNYDER CONTACT PFtONE:425-319-0122 COiVTACT EMAIL: STEVE.S@SEAPACHOMES.COM A6REEMENT.�The undersigned applicant a,qrees to comply with al!provisions of the Evere[f Municrpa!Code 7rt7e City of Everett Official Use Only 14 Waterand Sewer or such oiher rules and regulations now existing or which may 6e established from time to FEE time. 7he applicant/urther agreQs,as n condifion precadent lo receiving service that the uGlities c�ivision shall have the riqht at any time,withou!nofir,e,to sh��t off or tum on ihe water suppiy Ior repairs,construr.tion,and nonpayme of charge or for any other reasona67e cause.!am the owner,or!am authorized 6y the owner of this pmperty tn erlorm th ork for which appLcafion is made,and!comp7y with the State Confractors Law 18.27 PERMIT# RCW ard 96. OOk . 3-4-16 `�' I ��^�� OwnerlAuthorized Ag t Signature Date (Revised 09.�25i2oi5)