2715 HEWITT AVE SUBWAY 2017-10-20

Amw ATTR / SEWER UTILITY APPLICATION ML CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: IF APPLICABLE: ❑ OUTSIDE CITY LIMITS ❑ BUILDING AREA SF ❑ LOT# BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑DULEX ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL ❑INDUSTRIAL CHANGE OF USE? NO ❑YES, FROM TO UTILITY APPLICATION INFORMATION 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: INSTALL 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) ❑ 1 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: V, 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 INFORMATION OWNER NAME: 1 TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET CITYEVSTATE ZIP IDntil— V OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: CONTRACTOR ADDRESS: STREET y CITY STATE u ZIP e CONTRACTOR PHONE: " CONTRACTOR EMAIL: b f 11, Vb CITY OF EVERETT BUSIN LIC.#REQUIRED CONTRACTOR LIC.#(REQUIRED): ( ) PRIMARY CONTACT: ❑OWNER ❑ CONTRACTOR ❑ OTHER(Please Specify) CONTACT NAME: . CONTACT PHONE: MA�—f� CONTACT EMAIL: e, 1 e 111 AGREEMENT:The undersigned applicant agrees to comply with all provisions of the Everett Municipal ode Title City of Ever t Official Use Only 14 Water and Sewer or such other rules and regulations now existing or which may be established from time to FEE time. The applicant further agrees, a on r- n 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 rte`, nonpayment ch r s or or an other reasona le cause.I am the owner,or I am authorized by the owner of this property top or he we r hich applicatio is made,and I comply with the State Contractors Law 18.27 PERMIT# RCW and 29 200 WAC U m�-- bn wnerlAuthoriz gent Sig ature Date (Revised 10/1212015)