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WATER i SEWER UTILITY APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 FAX 425-257-8857 1 (E)everetteps@eyerettwa,gov I wmeverettwa,gov/perm its <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 3402 Broadway <br /> IF APPLICABLE: 0 OUTSIDE CITY LIMITS 0 BUILDING AREA SF El LOT# <br /> 11BUILDING TYPE: EISFR-DETACHED EISFR-ATTACHED EIDULEX []MULTI-FAMILY-#OF UNITS: OCOMMERdIAL 0INDUSTR1AL <br /> ICHANGE OF USE? El NO C YES, FROM TO <br /> UTILITY APPLICATION INFORMATION <br /> SEWER(check all that apply) WATER (check all that apply)! <br /> 0 SIDE SEWER REPAIR 0 NEW WATER SERVICE INSTALLATION <br /> El SIDE SEWER ALTERATION El COMPLETE SERVICE 0 METER ONLY; <br /> El NEW SIDE SEWER INSTALLATION SERVICE I METER USE: <br /> 0 INSTALL BACKWATER VALVE(outside the building) El SFR <br /> 0 SIDE SEWER CAP-OFF C1 MULTI-FAMILY-#OF UNITS: <br /> [I SIDE SEWER RECONNECTION 0 COMMERCIAL <br /> MULTIPLE DOMESTIC WATER SERVICES REQUEST WATER SERVICE TYPE I SIZE: (circle desired sizEi) <br /> E-1 I AM DECLINING MULTIPLE DOMESTIC WATER SERVICES FOR 0 DOMESTIC: 3/4", 1 2", j OTHER: <br /> MY MULTI-FAMILY DEVELOPMENT UNDER SINGLE OWNERSHIP. 11 IRRIGATION: 3/4", 1", 2", OTHER: <br /> El I AM OPTING TO INSTALL MULTIPLE DOMESTIC WATER El FIRE: 1", 2", 4", 6", 8",1 OTHER: <br /> SERVICES FOR MY MULTI-FAMILY DEVELOPMENT UNDER 0 DOMESTICIFIRE COMBO: 1", 2",I OTHER: <br /> SINGLE OWNERSHIP. FILL OUT REVERSE SIDE OF THIS FORM. <br /> CONTACT INFORMATION <br /> OWNER NAME: Peekay Inc. TENANT NAME If Cornmercialy Lover's <br /> OWNER MAILING ADDRESS: STREET 901 West Main Street <br /> c;r"Auburn STATE WA z,zP 98001 <br /> 9,93-351-5001 <br /> OWNER PHONE: OWNER EMAIL: jeff@peekay.com <br /> CONTRACTOR NAME: Sposari inc. dba Mr. Rooter Plumbing & Heating <br /> CONTRACTOR ADDRESS- STREET 2000 South 116th St <br /> ,,T, Seattle STATE WA zi 98001 <br /> CONTRACTOR PHONE:206-651-2917 TCOINTRACTOR EMAIL: charlenel@mrrootersea.com <br /> CONTRACTOR LIC.#(REQUIRED):MRROOP*022NE ICITY OF EVERETT BUSINESS LIC.#(REQUIR Q): 38080 <br /> PRIMARY CONTACT: El OWNER R CONTRACTOR 11 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:206-651-2917 <br /> L Charlene Lundgren CONTACT EMAIL: charlenel@mrrootersea.coml <br /> AGREEMENT:The undersigned applicant agrees to comply with all provisions of the Everett Municipal Code Title 14 Water and Sewer or such other njlel�s and regulations now <br /> existing or which may be established from time to time. The applicant further agrees,as a condition precedent to receiving service that the utilities divisioti shall have the right at any <br /> time,without notice,to shut off or turn on the water supply for repairs,construction,and nonpayment of charges or for any other reasonable cause./am the owner,or I am <br /> authorized by the owner of this property to perform the work for which application is made,and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> ItPERMIT# <br /> U <br /> jwnerlAuthorized Ag nt Si ture Date (Revised 912312016) <br />