3420 NASSAU ST 2018-01-04 - Laserfiche WebLink

��'C� � �G�I�G'� �1� �LQ 1�� 'f�1�0�� CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 � FAX 425-2�7-8857 � (E) everefteps@everettwa.gov � www.everettwa.gov/permits PRO.IEC'�' SI�'E d�l�012nii�.1�'1�� PROJECTADDRESS: �`�Z O � 'SS� S t`�- � �� tF APPLICA6LE: ❑OUTSIDE CITY LIMITS ❑ BUILQING AREA SF ❑ LOT# BUILDING TYPE: ❑SFR-DETACHED ❑SFR-�ATTACHED ❑DULEX ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL ❑INDUSTRIAL CHANGE OF USE? ❑NO ❑YES, FROM TO aJ"�ILvll"l( AFePLlCA°�'IOIa9 99VFORIVa�1°TIO� SEWER(check all that apply) WA7ER(check all that apply) �SIDE SEWER REPAIR ❑ NEW WATER SERVICE INSTALIATION ❑ 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 DECLWING MULTIPLE DOMESTIC WATER SERVICES FOR ❑ DOMESTIC: 3/4", 1", 2", OTHER: MY MULTI-FAMILY DEVELOPMENT UNDER SINGLE OWNERSHlP. ❑ �RRlGATION: 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 DEVELOPIVIENT UNDER ❑ DOMESTIC/FIRE COMBO: 1", 2", OTHER: SINGLE OWNERSHIP. F1LL OUT REVERSE S/D�'OF TH/S FORM. CONTACT INFORMATION �� OWNER NAME: �j�'"-� G►'V { � ri t �7� TENANT NAME(If Commercial): OWNER MAILIIVG ADDRESS: srREET �2� /1��C 5 Sat.� S"� cirY r�'� sTArE I.��- ziP �g Z� 1 OWNER PHONE: OWNER EMAIL: �.._._.,�,.�. �_.. ..�__,..,.__:�,. _ .�...�.�.�.....,._ , , CONTRACTOR NAME: 5�W�� (►2r�� 1 CONTRACTOR ADDRESS: srReeT Z �9.3 L� c,� `� C CITY STATE Ll� � ZIP � O �Z� CONTRACTOR PHONE: (�(p - - g I� I CONTRACTOR EMAIL: CONTRACTOR LIC.#(REc�UIRED): CITY OF EVERETT BUSINESS LIC.#(RECIUIRED): PRIMARY CONTACT. ❑OWNER ❑CONf M TRACTOR ❑ OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: CONTACT EMAIL: AGREEMENT.'The undersigned applicanf ag�ees to cornply with all provisions of the Everett Municipal Code Title City of Everett Official Use Only 14 Vl/ater and Sewer or such ofher rules and regulations now existing or which may be established from time fo FEE `� time. The applicant further agrees, as a condition precedent to receiving service fhat the ufilities division shaU have (� the right at any time,without notice,to shut off or turn on the water supply for repairs,construction,and ��(�_� nonpayrnenf of charges or for any other reasonable cause.l am fhe owner, or I am authorized by the owner of this properfy to perform the work for which appiication is made,and 1 comply with the Sfate Contiactors Law 18.27 PERMIT�j ` /j� RCW and 296.? C. � i / (�(/I r��--� �. ^ ��/ �� / � � �- ' O uthorize Agenf ignature Date (Revised 90/12/?095)