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WATER / SEWER UTILITY APPLICATIC)N <br /> GTY OF EVERE7?PERMIT SERVICES <br /> 3200 CEDRR STREET, EVERETT, WA 98201 <br /> {P)425-257-881� ( FAX 425-257-8857 � (E}everetteps@everettwa.gov � www.everettwa.gov/permits <br /> a!!i£�.l��^�' ��'€ �a�=�s►�w�rar�iu. <br /> .. ;� s� �. t r7• vral'.esra��.��rw��:. . . ... - <br /> PRo��cT Ao�REss: 27Q9 25th Street <br /> IF APPLICABLE: ❑ QUTSIOE CITY LIMITS ❑ BUILDING AREA SF ❑ LOT# <br /> BUILDiNG TYPE: �SFR-DETACHED ❑SFR-ATTACHED ❑DULEX ❑MULTI-FAMILY-#OF UNtTS: ❑COMMERCIAL ❑INDUSTRIAL <br /> CHANGE OF USE? �NO ❑YES, FRQM TO <br /> �iTt1 !TV AOO��f��AT�A�� ��C;Ag�AT�At/ . <br /> �. v��r�r ■ wr� r vs���vt� n � nati rvr� .. <br /> SEWER(check ali that apply) WATER(check all that apply) <br /> 0 SIDE SEWER REPAIR ❑NEW WAl'ER SERVICE INSTALLATION <br /> �SIDE SEWER ALTERATION ❑COMPLETE SERV{CE ❑METER ONLY <br /> ❑NEW SIDE SEWER INSTALLATION SERVICE/METER USE: <br /> ❑ INSTALL BACKWATER VALVE(outside the buitding} ❑SFR <br /> ❑SIDE SEWER CAP-OFF ❑MULTI-FAMILY-#O�UNITS� <br /> ❑SIdE SEWER RECONNECTION �COMMERCIAL <br /> MULTtPLE DOMESTIG WATER SERVICES REQUEST WATER SERVICE TYPE t SIZE:(circle desired si2e) <br /> ❑ I AM QECLINWG MULTIPLE DOMESTIC+NATER SERVICES FOR ❑ DpMESTIC; 3!4", 1", 2", 07HER: <br /> MY MULTI-FAMIL�'DEVELOPMENT UNDER SItVGLE GWNEI�SHIP. Q IRRIGATION: 3/4", 1", 2", OTHER: <br /> ❑1 AM OPTING TO INSTALL MULTIPLE DOMESTIC WATER �FIRE: 1", 2", 4", 6", 8", OTHER: <br /> SERVICES FOR MY MULTI-FAMILY DEVELOPMENT UNDER ❑ DOMESTlC/FIRE COMBO: 1", 2", OTHER: <br /> SINGLE OWNERSHIP. FIL!OUT REVERSE SIDE'OF THIS FOItM. <br /> CONTACT 1NFORMATtON <br /> OWNER NAME: Wytltl MCCOt'il'lICI( TENANT NAME(if Commercial): <br /> OWNER MAILING ApbRESS: srReer 2709 25th Street <br /> �R.,tverett STATE�H zia ytSLU� <br /> own�eR PHONe: 206-963-4123 owNeR ennAi�: wynn@aol.com <br /> CONTRAGTOR NAME: Sposari inc., dba Mr. Rooter Piumbing & Heating <br /> CONTFtACTORADDRESS: Sr�Eer2000 South 116th St <br /> ��Seattle STATE WA Z,P 98201 <br /> CONTRACTOR PNQNE:�OC-6�J'I-2�'I 7 CONTRACTOR EMAIL: CI't81'I8t1@I�t'i"iCCQOtBfSBa.G0Y1'I <br /> CONTRACTOR LiC.#{REQUIRED):�RROOP*OZ�NE CITY'OF EVERETT BUSlNESS LIG.#(RE�tUIRED):��BO$O <br /> PRtMARY CONTAC7: ❑OWNER C�CONTRACTOR ❑UTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:2O�-CrJ'I-Z9'I 7 <br /> Charlene Lundgren coNrACT ennA��: charienel@mrrootersea.COCl1 <br /> AGREEPdENT:The undersigned appticant agress to comply with all provisions af the Everett MunlclpaJ Code 7itle 14 Watet and Sewer or such other nrles and regulatlans now <br /> existing ar which may be esiabfished from trme to time. The applieant furthar agrees,as a condition precedenf to receivrng service lhat the utiiities division shat/have the nght at any <br /> time,wiihout notice,to shut off or fum on fhe wafer supply tor rapairs,constructi0n,and nonpayment of charges or fpr any other reasonable causs.J am the owner,or f am <br /> authorrzed by the owner of this property to perf Rn the work for wh1Ch 8ppliCa[ion is made,and 1 comply with the Sfate Contractors!aw 48.27 RCW and 296.200A WAC. <br /> City of Everett Oflicial Use Only <br /> PERMIT# <br /> � /C� .� U � � C� - 6� <br /> Owner/Authorized Agen Signatur Date (Revised 9I23J2016) <br />