2417 WALNUT ST 2017-09-25 - Laserfiche WebLink

From:Jennif;r Baker Fax:(844)697-3937 To: j Fax: (425)257-8857 Page 2 of 2 04/20/2017 8:3^o AM WATER I SEWER UTILITY APPLICATION 4Z77- CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, INA 98201 (P)x#25-257-8810 1 FAX 425-257--8857 ( (E)everetteps@evere fa-gov I www_everettiva-gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: �a Vll ltif m v. -�a LIFAPPUCABLE: EI ou snE C€TY LimiTS 0 BUIL1:TNGAREA SF C1 LOT# ILDING TYPE: DSFR-DETAC-#ED �fiFR-ATTACHED ODULEX 13MULTI-FAMILY4OF i3NITS: QCOMMERC1AL QINDUSTRIAL ANGE OF USE? 1PNO Q YES, FROM TO UTILITY APPLICATION INFORMATION SEINER(check all that apply) WATER{check all that apply) VSIDE SEL:n3ER REPAIR EI NEIN-WATER SERVICE INSTALLATION 171 SIDE SEWER ALTERATION 0 COMPLETE SERVICE 0 METER ONLY Q N2AI SIDE SEWER INSTALLATION SERVICE f METER USE: ❑INSTALL BACKWATER VALVE(outside the bUllding) 11 SFR ©SIDE SEWER CAP-OFF 11 MULTI-FAMILY-##OF UNITS- 0 SIDE SEWER RECONNECTION CI COMMERCIAL MULTIPLE DOMESTIC MATER SERVICES REQUEST WATER SERVICE TYPE I SIZE-(circle desired size) ©1 AM DECLINING MUL—nPLE DOMESTIC XUATER SERVICES FOR D DOMESTIC: 314", 1 , 2", OTHER: MY MULTI-FAMILY DEVELOPMENT UNDER SINGLE OWNERSHIP, Q IRRIGATION}: 314", 1", 2", OTHER: EI i ANI OPTING TO INSTALL MULTIPLE DOMESTIC WATER 0 FIRE: r', 2", 4", 6", 8", OTHER: SERVICES FOR A1fY MULTI-FAMILY DEVELOPMENT UNDER 11 DOMESTICIFIRE COMBO- 7" 2" OTHER: SINGLE OWN ERSHIP. FILL OUT REVERSE SIDE OF THIS FORM- C[ID TACT INFORMATION OWNER NAME: n }1 - Wan TENANT NAME(ff Commerciaf): OWNER AI AAL ING ADDRESS: �STREET CITY STATE Zip OWNER PHONE: OVtTf�1ER E>'�411.IL: CONTRACTOR NAIwE: CONTRACTOR ADDRESS: STRFE ?0 CITY i STATE 1' 21P f�I GIs CONTRACTOR PHONE: �(ej ,GI �j � -7� Z� COINTRACTOR EMAIL: ft i'�!� t1),0 3- (z �Yl CONTRACTOR LIC.##(REQU1RED):tV J RW 5 Dz(, 3 p CITY OF EVEREIT BUSINESS LIC.#(REQUIRED): PRIMARY CONTACT: 0 0WNER fpCONTRACTOR 11 OTHER(Please Specify) CONTACT MAIZE: CONTACT PHONE: 2t1& 41 -3 -7-7-7,9' r CONTACT ENTAIL: tom,�.. .�Cyt i Yl W S-et,Ut yyl AGREEMENT_71ts undersigned app.icent agrees to con pfy tvitfr all p ovisions of fh Everett-Municipal Code Trtle� City of Ever eft Official Use Only 14 LUater and Sewer or wch other rules and regulations not w existing or which may he establishr-a from time to time. The applicant farther agrees,as a condition pre;edent to receivirg service that the utilities division shall have EEE tho right at any Brite,w,thout notice to shut off orturn on the water supply for repairs,construcfiun,and nonpayment of charges or for any otherreasonable cause.I am the owner,or/am authorized by the owner of this p2eto perform the work for which Y'' a made,and i comply with the Sie Contrac2ors Law 18,27 PERMIT T# !Nan 29820f3AVW, �� a , o2S OwngLtS)Onatura Date (Revisedla/12/20'15)