3013 VICTOR PL 2018-01-05 - Laserfiche WebLink

, � -� ,�� - i� '-�� �� I�� 0�0 �� CITY OF EVERETT PER(1l11T SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 � FAX 425-257-8857 � (E) everetteps@everettwa.gov � www.everettwa.gov/permits P�� G�� N��I�t�`P�� PROJECT ADDRESS: ��I ` - IF APPLICABLE: ❑ OUTSIDE CITY LIMITS ❑ BUILDING AREA SF ❑ LOT# BUILDIf�G TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑DULEX ❑MULTI-FAMILY-#OF UNfTS: ❑COMMERCIAL ❑INDUSTRIAL CHANGE OF USE? � NO ❑YES, FROM TO lJ`fB�87'Y AP�I�BC�'�°G�� l��E�fd�`�°E��9 SEWER (check all that apply) WATER(check all that apply) �SIDE SEWER REPAIR ❑ NEW WATER SERVICE INSTALLATION ❑ SIDE SEINER 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 REQUES7 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 S/DE OF THlS FORM. CON�'ACT Ifo1FB�RMAT10�1 OWNER NAME: � /�� TEPIANT NAME (If Commercial): OWNER MAILIPIG ADDRESS: sTREET CITY STATE ZIP OWNER PHO�dE: OWNEFZ EtViA1L: COfVTRACTOR iU,4iV�E: COF1l"P2ACTOR ADDRESS: STREET ��f � o CITY � STATE � m ZIP CONTRACTOR PHOt�E: � '� COIVTRACTOR Ei1�AIL: � B � � CONTR,4CTOR LIC.#(REc1UIRED): � � � Cll"Y OF EVERETT BUSIi� LIC.#(REQUIRED): � PRIMARY CONTACT: ❑OWNER ❑ CONTRACTOR ❑ OTHER(Please Specify) COiVT,4CT IV 4iViE: COfV7ACT PFiOI�E: � c'�L''°i� -' �Z'� I �� I ��,,� ��, COIUTAC7 EIVIAIL: f � � �N - � � a. � AGREEMENT:The undersigned applicant agrees to comply with all provisions of the Everett Municipal ode Title Cify of Ever f Otficial Use Only 94 Water and Sewer or such other rules and regulafions now existing or which may be established from time to FEE time. 7he applicant further ayrees, S e cond�i n precedent to receiving service that the utilities division shall have �✓7 F, �J the right at any ' e, w' t notic , to shuf off o tum on the water supply for repairs, construcfion, and /'�� nonpayment f ch r s or or an other reasona`le cause. I am fhe otvner, or I am authorized by the owner of this � �D property to p or he wo hich applicatio is made,and I comply with the State Confracfois Law 18.?7 PERMIT# RCW and 7_9 �200 WAC /� � j � �� R �� � v wner/Authoriz gent Sig�afiure Date (Revised 10/12/2015)