1702 WETMORE AVE 2018-01-05 - Laserfiche WebLink

WA�� / ��Vi�� `�O�.I�'Y' ��IC�`�I�N 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 PRAJECY SIYE INFORMI4TIOW PROJECT ADDRESS: ��l 4 Z ��g(+� A� ��2�I 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 INFORMATION SEWER(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 SFRVICE/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 SIDE OF THIS FORM. CONTACT INFORMATION OWNER NAME:��r TENANT NAME(If Commerciai): OWNER MAILING ADDRESS: srREeT ��02 W h'�^c CITY �jt�C'� STATE � ZIP �l�2�\ OWNER PHONE: OWNER EMAIL: �.. _..... . ..... .. ...._. . ....,_... .. _ .. CONTRACTOR NAME: �.�F-� � E � � CONTRACTOR ADDRESS: srREeT c7 . 5 �e 5't" CITY STATE� ZIP �j�`O�o CONTRACTOR PHONE: ZO(o CONTRACTOR EMAIL: CONTRACTOR LIC.#(REC7UIRED): S�uTE'f t�01 l G�o CITY OF EVERETT BUSINESS LIC.#(RECIUIRED): (, o�J� ..,._., .��,.,.� _... _...�. . . ._. , . PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑ OTHER(Please Specify) CONT CT N�E: � � CONTACT PHONE: � zj�`�(ocj$1 ��G� �' CONTACT EMAIL: AGREEMENT.�The undersigned applicanf ag�ees to comply wifh all provisions of the Everett Municipal Code Title City of Everett Official Use Only 14 Water and Sewer or such other rules and regulations now existing or which may be established from time to FEE � time. The applicant further agrees, as a condition precedent to receiving service that the utilities division shall have the right 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 reasonaU/e cause.I am fhe owner,or I am authorized by the owner of this properfy to perform t ork for plicafion is made,and I comply with the Sfate Contractors Law 98.27 PERMIT# RCW and 296 �� ' t � I J O q�✓ ( �� Owner/Authorized Agent Signature ate (Revised 90/92/2015)