615 35TH ST 2017-10-26 - Laserfiche WebLink

r WATER / SEWER UTILITY APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 ( FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 615 35th St IF APPLICABLE: ❑OUTSIDE CITY LIMITS ❑ BUILDING AREA SF ❑ LOT# BUILDING TYPE: QISFR-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) 0 SIDE SEWER REPAIR ❑NEW WATER SERVICE INSTALLATION ❑ SIDE SEWER ALTERATION ❑ COMPLETE SERVICE ❑METER ONLY ❑NEW SIDE SEWER INSTALLATION SERVICE/METER USE: 0 INSTALL BACKWATER VALVE(outside the building) ❑SFR ❑SIDE SEWER CAP-OFF 13 MULTI-FAMILY-#OF UNITS: ❑SIDE SEWER RECONNECTION 171 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: ❑1 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 615 35th St ,-,TY Everett STATE WA ZAP 98201-4635 OWNER PHONE:425-583-8867 OWNER EMAIL: rhaller3@hotmail.com CONTRACTOR NAME: Sposari inc., Mr. Rooter Plumbing & Heating CONTRACTOR ADDRESS: ITREET2000 South 116th Ave p Seattle STATE Vv��/a 2,F 98168 CONTRACTOR PHONE:206-651-2917 1CONTRACTOR EMAIL: charlenel@mrrooterSea.COm CONTRACTOR LIC.#(REQUIRED);MRROOP*022NE ICITY OF EVERETT BUSINESS LIG#(REQUIRED):03080 PRIMARY CONTACT: 0 OWNER ❑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 Pram time to time. The applicant further agrees,as a condition precedent to receiving service that the utilities division shall have the tight at any time,without notice,to shut off or tum on the water supply for repairs,construction,and nonpayment of charges or for any other reasonable cause,i am the owner,or t am 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. City of Everett Official Use Only PERMIT# Charlene Lundgre /27!2017 u — c)- Owner/Authorized Agent Signal e a (Revised 9/2J/2016)