716 NILES AVE 2017-10-24 - Laserfiche WebLink

WATER/ SEWER UTILITY APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 (P)425-257-8810 FAX 425.257-8857 [ (E) everetteps@everettwa.gov www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 716 Niles Ave IF APPLICABLE: ❑OUTSIDE CITY LIMITS ❑ BUILDING AREA SF ❑ LOT# BUILDING TYPE: ❑SFR-DETACHED OSFR-ATTACHED ❑DULEX ❑MULTI-FAMILY-4 OF UNITS: ❑COMMERCIAL ❑INDUSTRIAL CHANGE OF USE? ❑NO ❑YES, FROM TO UTILITY APPLICATION INFORMATION '! SEWER(check all that apply) WATER(check all that apply) 0 SIDE SEWER REPAIR ❑NEW WATER SERVICE INSTALLATION ❑SIDE SEWER ALTERATION ❑COMPLETE SERVICE ❑METER ONLY ❑NEW SiDE SEWER INSTALLATION SERVICE i METER USE: ❑ INSTALL BACKWATER VALVE(outside the building) ❑SFR ❑SIDE SEWER CAP-OFF ❑MULTI-FAMILY-#OF UMTS: SiDE SEWER RECONNECTION ❑COMMERCIAL MULTIPLE DOMESTIC WATER SERVICES REQUEST WATER SERVICE TYPE/SIZE: (circle desired size) ❑I 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: 111 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 INFORMATION OWNER NAME: Ralph Haller TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET 716 Niles Ave CITY Everett STATE v Y,J�J A 1, 98201 OWNER PHONE:425-418-6996 OWNER EMAIL: rhaller3@hotmali.Com CONTRACTOR NAME: Sposari inc., dba Mr. Rooter Plumbing & Heating CONTRACTOR ADDRESS: sTRE,2000 South 116th St CITY Seattle STATE A ZIP 9201 Y v CONTRACTOR PHONE:206-651-2917 CONTRACTOR`EMAIL; charlenei@mrrootersea.COm CONTRACTOR LIC.#(REQUIRED):MRROOP*022NE ICITY OF EVERETT BUSINESS LIC.#(REQUIRED):036080 PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:206-651-2917 Charlene Lundgren CONTACT EMAIL: Charlenel@mrrootersea.Com AGREEMENT.The undersigned applicant agrees to comply with all provisions of the Everett Municipal Code Title 14 Water and Sewer or such other rules and regulations now existing or which may be established train time to time.The applicant further agrees,as a condition precedent to receiving service that the utilities division';,shall have the right at any 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.i am the owner,or t am Zlene d the owner of this property top rm the work for which application is made.and l comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Oficial Use Only PERMIT f Lundgr 3/22/2017 U Owner/Authorized Agent Signature Date (Revised 9/23/2016)