1407 E MARINE VIEW DR 2018-01-04

�� .�� I��O � 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 PROJECY S17'E IPIFORMA'TION PROJECT ADDRESS: � � .J�!,�;I_' ��„!�P `) l3 V^i '�I— � � �`: " T�` <L Y��'-��: ( IF APPLICABLE: ❑OUTSIDE CITY LIMITS ❑ BUILDING AREA SF ❑ LOT# BUILDING TYPE: FR-DETACHED ❑SFR-ATTACHED ❑DULEX ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL ❑INDUSTRIAL CHANGE OF USE? '�0 ❑YES, FROM TO UTILITY APPLICATION INFORMATION SEWER(check all that apply) WATER(check all that apply) [�l 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. FILL OUT REVERSE SIDE OF THIS FORM. CONTACT INFORMATION OWNER NAME: ��-�1 f OL�� TENANT NAME(If Commercial): OWNER MAILWG ADDRESS: sTReEt �O� � "�' `-, '' L�� ' J �' �U t -�' ��.- ..•� CITY C L.� � �I STATE ZIP OWNER PHONE: OWNER EMAIL: _..__.... _..,__.._,_. _..... ._..__.__ . _ ,. CONTRACTOR NAME: C� �T � � �% I:l 7'�l'� CONTRACTOR ADDRESS: sTREET r L � . I� � - ! CITY ��'��.�/ �`� STATE V"�� ZIP�� CONTRACTOR PHONE:`�L' ��3 �i�t �' CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED): ��1"��J`��c �/ f; C(TY OF EVERETT BUSINESS LIC.#(REQUIRED)�� .�j �' _. _._... :__:_ _.� � . . _ . _.. PRIMARY CONTACT: ❑OWNER �"bNTRACTOR ❑ OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: �v� `' ` � �� C% _� CONTACT EIVIAIL: AGREEMENT.'The undersigned applicant agrees to comply with all provisions of the Everett Municipal Code Title City of Everett Official Use On/y 94 Water and Sewer or such other rules and regulations now existing or which may be established from time to FE E time. The applicant further agrees, as a condition precedent to receiving service that fhe utilities division shall have � `�f the righf 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.1 am the owner,or I am authorized by the owner of fhis prope�ty to peiform the work for which application is made,and I comply with tire State Contracfors Law 18.27 PERMIT# RCW and?_96.200A WAC. � I � � � y �y� --� �=,x�-� �� '��. /� �, U t Owner/Aufhorized Agent Signature Date (Revised 90/12/2015)