621 HOYT AVE 2018-01-04 - Laserfiche WebLink

Oct 31 2017 1027AM CJ'S PLUMBING & SERVICE 360-691-1301 page 1 WATER / SEWER UTILITY APPLlCATION CITY aF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 {P) 425-257-8810 � FAX 425-257-8857 � (E) everetteps@everettwa.gov � www,everettwa.gov/perrnits PR�3JECT SITE INFORMATION PROJECT ADDRESS: 62"1 HOyt AV@ EVEfeYt IF APPLICABLE: ❑ OUTSIDE CIN LIMITS ❑ BUILDING AREA_ SF ❑ LOT# BUfLDING TYPE; ❑SFR-DETACNED ❑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 lNSTALLATION SERVICE 1 METER USE: ❑INSTALL BACKWATER VALVE(outside the building) � SFR ❑SIDE SEWER CAP-OFF � MULTI-FAMILY-#OF UNITS: ❑ SIDE SEWER RECaNNECTION ❑COMMERCIAL MULTIPLE DOMESTIC WATER SERVICES REQUEST WATER SERVICE TYPE/SIZE: (circle desired size) ❑ I AM DECLINING MULTIPLE DOMESTIC WATER SERVICES FOR ❑ DOMESTlC: 3/q" 1" 2" OTHER MY MULTI-FAMII�Y DEVELOPMENT UNDER SINGLE OWNERSHIP. ❑ IRRIGATION: 3/4", 1", 2", p7HER: ❑ I AM OPTING TO INSTALL MULTIPLE DOMESTIC WATER ❑ FIRE' 1"; 2", 4", 6", 8", OTHER: SERVICES FOR MY MULTI-FAMILY DEVELOPMENT UNDER p DOMESTIC/FIRE COMBO: 1", 2", OTHER: SINGLE OWNERSHIP. FILL OUT REVERSE S/DE OF THlS FORM. CONTACT INFORMATI�N OWNER NAME: Caf01111e SnOW TENANT NAME(If Commercial : OWNER MAILING ADDRESS: srREEr 621 Hoyt Ave c�rr Everett STArE Wa z,P 98201 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: C.I'S PLUMBING & SERVICE LLC CONTRACTOR ADDRESS: sTReeT 5528 218TH AVE NE �,�, GRANITE FALLS STATE WA z,P 98252 CONTRAGTOR PHONE: 360-691-5159 CONTRACTOR EMAIL: C�SPLUMBING�MSN.COM CONTRACTOR LIC.#�REQuiReo�:CJSPLPS9150D CITY OF EVERETT BUSINESS UC.#(REQU�RED: 047970 PRIMARY CONTACT: ❑OWNER �CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:425-23'I-7�58 CHRIS CONTACT EMAIL; AGREEMENT, The undersigned eppiicanf agrees fo comply with a!/provisrons ol the Everett Municipel Code T�tle i4 lNater and Sewer or such other rules and regulalions now exlsfinq or whrch may be esfablished fiom tlrrre to time. The applicant lurther agrees,as a condifion prBcedent to 2ceiving sen•iC9 that the utilities divrsion shall have the right af any time,wifhouf nofice, to shut off or lum on the water supply for repa�rs,construction, and nonpayment of Chaiges or/or any other reasonable cause. I am the owne� or 1 am authonzed by the owner of ihrs propeity to perform fhe work for which application is made,and l cnmply wifh fhe State Contractors Law 18.27(ZCW and 296 200A WAC. City of Everett OHicral Use Only PER ` ; " ` '` �� l U � � �'�'"�� OwnedAuthorized Agenf Signat re !]ate (Revised 9/'23/7016)