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0 • <br /> WATER / SEWER UTILITY APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 l FAX 425-257-8857 l (E)everetteps at leverettwa.gov l www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 2109 Melvin Ave Everett WA 98203 <br /> IF APPLICABLE: ❑ OUTSIDE CITY LIMITS ❑ BUILDING AREA SF ❑ LOT# <br /> BUILDING TYPE: EISFR-DETACHED ❑SFR-ATTACHED ❑DULEX ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL ❑INDUSTRIAL <br /> CHANGE OF USE? ❑NO ❑YES, FROM TO <br /> UTILITY APPLICATION INFORMATION <br /> SEWER(check all that apply) WATER(check all that apply) <br /> 0 SIDE SEWER REPAIR ❑ NEW WATER SERVICE INSTALLATION <br /> ❑ SIDE SEWER ALTERATION ❑ COMPLETE SERVICE ❑ METER ONLY <br /> ❑ NEW SIDE SEWER INSTALLATION SERVICE/METER USE: <br /> ❑ INSTALL BACKWATER VALVE(outside the building) ❑SFR <br /> ❑ SIDE SEWER CAP-OFF ❑ MULTI-FAMILY-#OF UNITS: <br /> ❑ SIDE SEWER RECONNECTION ❑ COMMERCIAL <br /> MULTIPLE DOMESTIC WATER SERVICES REQUEST WATER SERVICE TYPE I SIZE: (circle desired size) <br /> ❑ 1 AM DECLINING MULTIPLE DOMESTIC WATER SERVICES FOR ❑ DOMESTIC: 3/4", 1", 2", OTHER: <br /> MY MULTI-FAMILY DEVELOPMENT UNDER SINGLE OWNERSHIP. ❑ IRRIGATION: 3/4", 1", 2", OTHER: <br /> ❑1 AM OPTING TO INSTALL MULTIPLE DOMESTIC WATER ❑ FIRE: 1", 2", 4", 6", 8", OTHER: <br /> SERVICES FOR MY MULTI-FAMILY DEVELOPMENT UNDER ❑ DOMESTIC/FIRE COMBO: 1", 2", OTHER: <br /> SINGLE OWNERSHIP, FILL OUT REVERSE SIDE OF THIS FORM. <br /> CONTACT INFORMATION <br /> OWNER NAME: Carla Strongberg TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 2109 Melvin Ave <br /> c,,Everett STATE WA „p 98203 <br /> OWNER PHONE: 425-501-2540 1OWNER EMAIL: <br /> CONTRACTOR NAME: Sposarl inc, dba Mr. Rooter Plumbing <br /> CONTRACTOR ADDRESS: STREET 2000 South 11 6th St <br /> ,,,,, Seattle STATE WA Z 98168 <br /> CONTRACTOR PHONE:206-651-2917 CONTRACTOR EMAIL: Charlenel@mrrootersea.Com <br /> CONTRACTOR LIC.#(REQUIRED):MRROOP*022NE ICITY OF EVERETT BUSINESS LIC.#(REQUIRED):038066 <br /> PRIMARY CONTACT: ❑OWNER I2 CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:206-651-2017 <br /> Charlene CONTACT EMAIL: charlenel@mrrootersea.com <br /> AGREEMENT:The undersigned applicant agrees to comply with all provisions of the Everett Municipal Code Title 14 Water aria Seweror such other rules 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 division shall have the right at any <br /> time,withm,t notice,to shut off or turn on the water supply for repairs,construction,and nonpayment of charges or for any other reasonable cause.I am the owner,or I am <br /> authorized by the owner of this property to perform the work for which application is made,and t comply with the State Contractors Law 18.27 RCW and 296.ZOOA WAG. <br /> City of Everett Official Use Only <br /> PERMIT <br /> Owne/rfAuthorized Agent Signat�i'� Date (Revised 9/23/2016) <br /> fir, <br />