6510 CADY RD 2017-10-03 - Laserfiche WebLink

WATER B SEWER UT UTY « PPUCAMN CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 FAX 425-257-8857 1 (E) everetteps@everettwa.gov www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: IF APPLICABLE: ❑ OUTSIDE CITY I ITS ❑ BUILDING AREA SF ❑ LOT# BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑DULEX ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL ❑INDUSTRIAL CHANGE OF USE? NO ❑YES, FROM -TO U` ELE` Y GilPPLECATNON, NI NFORMA`1TION SEWER (check all that apply) WATER(check all that apply) SIDE SEWER REPAIR ❑ NEW WATER SERVICE INSTALLATION ❑ SIDE SEWER ALTERATION ❑ COMPLETE SERVICE ❑ METER ONLY ❑ NEW SIDE SEWER INSTALLATION SERVICE/METER USE: JI jNSTALL BACKWATER VALVE(outside the building) ❑ SFR ❑ SIDE SEWER CAP-OFF ❑ MULTI-FAMILY-#OF UNITS: ❑SIDE SEWER RECONNECTION ❑ COMMERCIAL MULTIPLE DOMESTIC WATER SERVICES REQUEST WATER SERVICE TYPE/SIZE: (circle desired size) 111 AM DECLINING MULTIPLE DOMESTIC WATER SERVICES FOR ❑ DOMESTIC: 3/4", 1", 2", OTHER: MY MULTI-FAMILY DEVELOPMENT UNDER SINGLE OWNERSHIP. ❑ IRRIGATION: 3/4", 1", 2", OTHER: ❑ I AM OPTING TO INSTALL MULTIPLE DOMESTIC WATER ❑ FIRE: 1", 2", 4", 6", 8", OTHER: SERVICES FOR MY MULTI-FAMILY DEVELOPMENT UNDER ❑ DOMESTIC/FIRE COMBO: 1", 2", OTHER: SINGLE OWNERSHIP. FILL OUT REVERSE SIDE OF THIS FORM. CONTACT ENFORMATION OWNER NAME: TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET CITY STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: KA i CONTRACTOR ADDRESS: STREET401 rNa /� • CITY STATE • ZIP CONTRACTOR PHONE: PIP& CO TRACTOR EMAIL: WW• f CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINEIS4 LIC.#(REQUIRED): 0 PRIMARY CONTACT: ❑OWNER ❑ CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: /9��!vH16 CONTACT EMAIL: AGREEMENT The undersigned applicant agrees to comply with all provisions of the Everett Municipal dode Title City of Ever f Official Use Only 14 Water and Sewer or such other rules and regulations now existing or which may be established from time to F E E time. The applicant further agrees, a con i' precedent to receiving service that the utilities division shall have the right at any ' e,w' t notic ,to shut off o turn on the water supply for repairs,construction,and nonpayment c s or or enj other reasons !e cause.I am the owner,or I am authorized by the owner of this — property to pWent plicatio is made,and I comply with the State Contractors Law 18.27 PERMIT# RCW and 29 U wnerlAuthDate (Revised 10/12/2015) v