6315 RAINIER DR 2018-01-04 - Laserfiche WebLink

W�`�ER / ��V'U�� 'O�I�Y ��,�CA.`�IOfV 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 PRAJEC7' SI'TE INFORNiAT10� PROJECTADDRESS: (/, �I S iz-i r.� �, �� IF APPLICABLE: ❑ OUTSIDE CITY LIMITS ❑ BUILDING AREA SF ❑ LOT# BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑DULEX ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL ❑INDUSTRIAL CHANGE OF USE? �NO ❑YES, FROM TO UTILITY APPLICATION INFORMATIOW SEWER(check all that apply) 1NATER(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. F1LL OUT REVERSE SIDE OF THIS FORM. CONTACT INFORMATION OWNER NAME: � j � �U � r ��. TENANT NAME(If Commercial): OWNER MAILING ADDRESS: sTREET �� ? 1 > /��+/I�E �- � - L ,�✓tt� CITY STATE / ��'� ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: �(v�ti !� �- �C CONTRACTOR ADDRESS: sTREeT 4�1p/�� Z Z •"�''� S 1--S�v CITY //j' `��G�,+ -L IC� -L/�-j/Q � STATE CV� �` ZIP C��._ CONTRACTOR PHONE: ��`,- Z ''-3` S— CONTRACTOR EMAIL: � ��;�� .�- � '�'� �r'��+C. �-]� `�� CONTRACTOR LIC.#(REQUIRED): /�1✓.ti!!� `i 33 ✓L- CITY OF EVERETT BUSINESS LIC.#(REQUI D): __.m�-,.,...,� .... ._..._ .... , .� PRIMARY CONTACT: ❑OWNER ;Q CONTRACTOR ❑ OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: z u�> ��s'�'- �� S— �V��J't�/-�� CONTACT ElliIAIL: /✓1? �1 c, �. ,� � , --�- 9�J 7"/ � � 1 Cc� �C.Gr S • .G F AGREEMENT:The undersigned applicant agrees to comply with all provisions of the Everett Municipal Code Tifle City of Everett Offcial Use Only 94 Water and Sewer or such ofher rules and regulatrons now existing or which may be established from time to FEE time. The applicanf further agrees, as a condition precedent to receiving service thaf the utrlities divisron shall have the right af any time,witl�out notice,to shut off or turn on the water supply for repai�s,construction,and nonpayment of charges or for any other reasona6le cause.1 am the owner,or l am authorized by the owner of this property to perform the work for which application is made,and 1 comply with the State Confracfors Law 18.27 PERMIT# RCW an�296200A WAC. � � 3. `, 7 � Gt� ��F��c'�! �L� _2 _ ''/ Owner/Authorized Agent Signature Date (Revised 90/92/2095)