3507 86TH ST SE 2019-01-22 - Laserfiche WebLink

TER / SEWE!'", UTILITY WPUICATI•N CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 1 (E) everetteps@everettwa.gov ( www.everettwa.gov/permits PROJECT SITE INFORMATIOF1 PROJECT ADDRESS: .4®? 8616E Eu g E 1 1' tz,-,4 , IF APPLICABLE: UTSIDE CITY LIMITS 0 BUILDING AREA 6. ?, SF 0 LOT# BUILDING TYPE: $46FR-DETACHED ❑SFR ATTACHED ❑DULEX ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL ❑INDUSTRIAL CHANGE OF USE? ❑NO ❑YES, FROM TO UTILITY APPLICATION INFORMATION h SEWER(check all that that applyy) WATER(check all that apply) ❑SIDE SEWER REPAIR 0 NEW WATER SERVICE INSTALLATION o SIDE SEWER ALTERATION XCOMPLETE SERVICE 0 METER ONLY KNEW SIDE SEWER INSTALLATION SERVICE/METER USE: ❑ INSTALL BACIMIATER VALVE(outside the building) $SFR t400 +i' ❑SIDE SEWER CAP-OFF 0 MULTI-FAMILY-#OF UNITS: ❑ SIDE SEWER RECONNECTION 0 COMMERCIAL _ MULTIPLE DOMESTIC WATER SERVICES REQUEST WATER SERVICE TYPE/SIZE:(,r ; ,- ' :••size) / pC ❑ I AM DECLINING MULTIPLE DOMESTIC WATER SERVICES FOR XDOMESTIC: 3/4" > 2", OTHER:'` 21d1(0 OWNERSHIP. " 1", OTHER: MY MULTI-FAMILY DEVELOPMENT UNDER SINGLE 0IRRIGATION: 3/4, 2 , ❑ 1 AM OPTING TO INSTALL MULTIPLE DOMESTIC WATER 0 FIRE: 1", 2", 4", 6", 8", OTHER: SERVICES FOR MY MULTI-FAMILY DEVELOPMENT UNDER 0 DOMESTIC/FIRE COMBO: 1", 2", OTHER: SINGLE OWNERSHIP. FILL OUT REVERSE SIDE OF THIS FORM. CONTACT INFORMATION. OWNER NAME: T o,Ji9ikiz d A^LEA TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET 101 a 1 g 'f.RC REEd Lint' su,k p`t 5 l 6 5 EuE ki 17 pCITY tA)A �v q STATE ,] ZIP OWNER PHONE: 013"i/ eo OWNER EMAIL: Re)NI/7 L fi I`[o, ,e ``, �/p 000,da �J M. {� .. ".. CONTRACTOR NAME: 'O'OMAS'7< 140-71415 7�C J CONTRACTOR ADDRESS: STREET ?P.0, e 0 DC 1/ 6 CITY ill/ME.:7 STATE (/V/' /t ZIP A CONTRACTOR PHONE: lig6- ihad./6134R CONTRACTOR EMAIL: DY6146/Y go EE5/ ) t &eel CONTRACTOR LIC #(REQUIRED) «y � ____ CITY OF EVERETT BUSINESS•LIC.#(REQUIRED): , ,PRIMARY PRIMARY CONTACT: OWNER ❑CONTRACTOR 0 OTHER(Please Specify) ACT NAME: CONTACT PHONE: 14616 - s o g 43 8 0 etd ig )k CONTACT EMAIL: 1 `0 At AJ i 13 q3 j(d 'Alke.�.• //// AGREE ENT:The undersigned applicant agrees to comply with all provisions of the Everett Municipal Code Title City of Everett Official Use Only 14 Water and Sewer or such other rules and regulations now existing or which maybe established from time to FEE time.The applicant further agrees, as a condition precedent to receiving service that the utilities division shall have I^ , /,� l l� 6 the right at any time,without not/c-. shut off or turn on the water supply for repairs,construction,and '/%� (r/I _. non. - . :rges or for- y othe reasonable cause.I am the owner,or I am authorized by the owner of this j.roperty to perfo, thew• I or which=pplication is made,and I comply with the State Contractors Law 18.27 PERMIT# 006'CW and 29• OOAW �/ A PE �>'"� (� //1 EP 0 e 01°2 ' 9 . Own-/Auth• ized Agent Signature - Date (Revised 10/12/2015)