1917 78TH PL SE 2017-06-29 - Laserfiche WebLink

W� ER / SEWER UTILITY � PLIGATION CITY OF EVERETT PERMIT SERVECES 3200 CEDAR STREET, EVERETT, WA 982Q1 (P}425-257-8810 � FAX 425-257-8857 � (E)everetteps�a everetiwa.gov � uvww.everettwa.gov/permits PROJECT SITE INFORMATION PROJECTADDRESS: 1917- 78TH PL SE EVERETT WA 98204 IF APPLICABLE: ❑ OUTSIDE CITY LIMI7S ❑ BUILDING AREA z435 SF ❑ LOT# 12 BUtLDING TYPE: �SFR ❑ MULT!-FAMILY ❑COMMERCIAL ❑ INDUSTRIAL CliANGE OF USE? �NO ❑YES, Ff20M TO UTILlTY APPLICATION INFORMATION SEWER(check all that apply) WATER(check all fFiat apply) I�SIDE SEWFR REPAIR �NEW WATER SERVICE INSTALLATION ❑SIDE SEWER ALTERATION C! COMPLETE SEFtVICE � METER ONLY � NEW SIDE SEWER INSTALLA710N SERVICE!METER USE: L7 tNSTALL BACKWATER VALVE (outside the building) �SFR ❑SIDE SEWER CAP-OFF ❑ MULT(-FAMILY-#aF UN17S: ❑S[DE SEWER RECONNECTIQN � COMMERCIAL MULTIPLE DOMESTIC WATER SERVICES REQUEST WATER SERVECE TYPE J SIZE:(circle desired size) ❑I AM DECLINING MULTIPLE QOMESTIC WATER SERVICES FOR ❑ DOMESTIC: 3/4", 1", 2", C3THER: MY MULTI-FAMILY DEVELOPMENT UNDER 51NGLE OWNERSHIP. ❑ �RR(GATION: 314", 9", 2", OTHER� ❑ I AM OPTING TO INSTALL MULTfPLE DOMESTIC WA7ER ❑ FIRE; 1", 2", 4", �� 8", OTHER: SERVICES FOR MY MULTI-FAMILY DEVELOPMENT UNDER �] pOMESTlC/F1RE COMBO: �", � 2", OTHER: SINGLE OWNERSHIP. FILL OUT REVFRSE SIDE OF THlS FORM. v C�NTACT fNFORMATION OWNER NAME:ALPINE HEIGHTS LLC TENANT NAME(If Commercial): OWNER MAILiNG ADDRESS: sTnEST 120 SW EVERETT MALL WAY SUITE 100 ciTv EVERETT s7ArE WA ZiP 98204 OWNERPH�NE: 360-953-280o OWNEREMAlL: www.SEAPACHOMES.COM CONTRACTOR NAME: SEA PAC HOMES CONTRACTOi2ADDRESS: s�� 120 SW EVERETTT MALL WAY SUITE 100 crrv EVERETT srare T^1A ziP 98204 CONTRACTOR PNONE 3 6 0-9 5 3-2 8 0 0 CONTRACTQR�MAIL: WWW.S EAPACHOMES.COM CONTRACTOR LICENSE#(REQuiR�n�: CtTY OF EVERETT BUSINESS LICENSE#{REQUIRe�}: _ __ _. _ _ __ _ PRIMARY CONTACT: ❑OWNER �CONTRACTOR ❑OTHER(Piease Specify)_ ___ CONTAC7 NAME: STEVE SNYDER CONTAC7 PFlONE:42 5-319-012 2 CONTACT EMAiL: STEVE.S@SEAPACHOMES.COM AGREFMENT�The undersigned applrcant agrees to comply wilh aJ!pravisions of the Everett M�nicrpal Code T'�i7e Cify of Everett O�cial Use Only 14 Waterand Sewer or such ofhar rules and regulations now existing or which may 6e establ�shed from time fo FEE fime. The app/icant�urther agreQs,as a condition precedent to recerving service that the utifrties division shall hava the right at any[ime,without notice,to shul offortum on the wafersup,oly forrepairs,construction,and nonpayme ot charge or for any nther reasonable cause.f am the owner,or!am authorized by the owner oi this pmperry to edorm th ork for which appLcation is made,and 1 comply wilh the State Cnntractors Law 98.27 PERMIT# RCW a d 9G. OOA . r ( 3-4-16 V � 11J��- ��11 OwnerlAuthorized Ag t Signature Da:e (/7evised 09.%25/2015)