1923 78TH PL SE 2017-06-29 - Laserfiche WebLink

W� ER / SEWER UTILITY . 'PLICATION CITY OF EVERE'TT PERMIT S�RV(CES 3200 CEDAR S�I E�EET, EVERETT, WA 98201 {P)425-257-8810 � FAX 425-257-8857 � (E) everetteps@everettwa.gav � uvww.everettwa.gov/permits PROJECT SITE INFORMATION PROJECTADi7RESS: 1923- 78TH PL SE EVERETT WA 98204 IF APPLiCABLE: ❑ OUTSIDE CITY LIMI`f"S ❑ BUILDING AREA 1816 SF ❑ LOT# 10 Bl1iLDING TYPE: �SFR ❑ MULTI-FAMILY ❑GOMMERCIAL ❑ INDUSTRIAL CHANGE OF USE? �NO ❑YES, FROM TO UT1LlTY APPLICATION INFORMATION SEWER (che�k all that apply) WATER(check ali#hat apply) ❑SIDE SEWE�R REPAIR �NEW WATER SERVICE(NSTALL�ITION �SlDE SEWER ALTER,4TION ❑ COMPLETE SERViCE � METER ONLY � NEW SIDE SEWER INSTALLA710N SERVICE 1 METER USE: � INSTALL BACKWATER VALVE (outside the building) �SFR ❑SIDE SEWER CAP-aFF ❑ MULT(-FAMILY-#OF UN1TS: � S(DE SEWER RECONNECTION � COMMERCIAL MULTlPLE DOMESTIC WATER SERVICES REQUEST WATER SERVECE TYPE/SIZE: (circle desired size) � I AM DECLINING MULT(PLE aOMESTIC WATER SERVICES FOR ❑ DOMESTIC: 314", 1", 2", OTHER: MY MUI.TI-FAMILY DEVELOPMENT UNDER 51tVGLE OWiVERSNIP. ❑ ��RIGATION: 314", 1", 2", OTNER: ❑ I AM OPTING TO 1NSTALL MULTfPLE DOMESTIC WA7ER ❑ FIRE: 7", 2", 4", 6", 8", OTHER: SERVICES FOR I�1Y MULTI-FAMlLY DEVELOPMENT UNDER B] pOMESTiClFIRE COMBO: 1", 2", OTHER: SINGLE OWNERSHlP. FlLL OUT REVERSE SIDE�F TNlS FORM. CONTACT iNFORMATION OWNER NAME:ALPINE HEIGHTS LLC TENANT NAME(If Commercial): aWNER MAILING ADDRESS: s�x�tT 120 SW EVERETT MALL WAY SUITE 100 cirv EVERETT sTArE wA ZiP 98204 OWNER�HONE: 360-953-2800 OWNEREMAIL: WWW.SEAPACHOMES.COM CONTRACTOR NAME: SEA PAC HOMES COTITRACTOR ADDRESS: s�e� 120 SW EVERETTT MALL WAY SUITE 100 crrv EVERETT srAre wA z�P 98204 CONTRAGTOR PHONE 3 6 0-95 3-2 8 0 0 CONTRAC70R EMA1L: WWW.SEAPACHOMES.COM CONTRACTOR LICENSE#{REQUIRI=D): CITY OF EVERETT BUSINESS LICENSE#{REQUIRED): PRIMARY CONTACT: ❑OWNER �CONTRACTOR ❑OTHER(Please Specify)_______�_ _ _ CONTAC7 NAME: STEVE SNYDER CONTACT PHONE:425-319-0122 C�NTACT EMAiL: STEVE.S@SEAPACHOMES.COM AGREEMENT. The undersi,qned applrcant a,qrees to comply with a!!provisic�ns of the F_veretf Municipal Code l ifle City of Everett O�cia!Use Only 14 Waferand Sewer or such othar rules and regulafions now existinq or which may 6e estahlished from trrne to FEE trme. 7he applir.anl turther agrees,as a condifion precedent to receiving service that the ufi/ities division shall have the right af any fime,withoui notice,to shu!off or fLm on ihe water supply�or repairs, constn�r,tion,and nonpayme of charge�or for any other reasonabte cause.1 am the owner,or 1 am au[t�orized 6y fhe owner or this property fo edorm ih ork for which appLcaUon is made,and 1 comp7y with Ihe State Contractors Law 78.27 PERMIT'# 12C lN a d 9G. OOA . 3-4-16 � OwnerlAuthorized Ag t Signature pate (Revised 09i25/20i5j ` �.i; �•. �.