3315 HOYT AVE 2018-01-04 - Laserfiche WebLink

N�Q�� 1� �l�0[�Q�� ap�L�9��8�� CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 � FAX 425-257-8857 � (E) everetteps@everetiwa.gov � www.evere#twa.gov/permits PFi0.9EC'�'SI'�� 16�l��R�iie�'Ti�RI PROJECT ADDRESS: ( J J �J£IZ£1-i G�/.4 iF APPLICABLE: ❑OUTSIDE CITY LIMITS ❑ BUILDING AREF� SF ❑ LOT# BUILDWG TYPE: �SFR-DETACHED ❑SFR-ATTACHED ❑QULEX ❑MULTI-FAMILY�#OF UNITS: ❑COMMERCIAL ❑INDUSTRIAL CHANGE OF USE? �NO ❑YES, FROM TO l�"rIL9`i`l(APPLICA`�'IOR9 91VF'ORMA'Tl��d SEllVER(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 INSTALLATION SERVICE/METER USE: ❑ INSTALL BACKWATER VALVE(outside the building) ❑ SFR ❑ SIDE SEWER CAP-OFF ❑ MULTI-FAMILY-#OF UNITS: ❑ 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: ❑ I 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. F/LL OUT REVERSE S1DE OF THIS FORM. CONTACT INFORMATION OWNER NAME: C � L TENANT NAME(If Commercial): ��S ��L�'� OWNERMAILINGADDRESS: srReET-332. IZ�+o,eoA- HYS �p Ak� 51'c✓cti crrY W/'� STATE �l�Z� Z1P OWNER PHONE: OWNER EMAfL: CONTRACTOR NAME: �c,/•v CONTRACTOR ADDRESS: srREEr C�.n, STATE Z�P CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED): _ EQUIRED): CITY`OF EVERETT BUSINESS LIG (R ,;,. T. , w-,.-•,•, ....__.�..-.._,.�..�_.�_� ,�..:._, ,_....: _:,.... _....._.. .. . �_„ PRIMARY C0IVTACT: �OWNER ❑CONTRACTOR ❑ OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: LJZS• 33� - 7395 e�+r�s �/�hL� CONTACT ENiAIL: AGREEMENT.'The undersigned applicanf agrees to comply with all provisions of the Everetf Municipal Code Tifle City of Everetf Otficial Use Only 94 Vl/afer and Sewer or such oiher rules and regulations now existing or which may be established from time to FEE fime. The applicant further agrees, as a condition precedent to receiving service that the utilifies drvision shall have fhe rrght at any time,without notice,to shut otf or tum on the water supply for repairs,consfruction,and �'— nonpayment of charges or for any other reasonable cause.I am the owner, or I am authorized by the owner of this property to perform fhe work for�vhich application is made,and I comply with the Sfate Confracfors Law 18.27 pERMIT# RCW an�20 A WAC. � ��( O _ �O lo -lo-� � Owner/Authorized Agent Signature Date (Revised 10/12/7_095)