3316 HOYT AVE B 2018-01-31 - Laserfiche WebLink

w�� s�w�R u-ri�i�rY ��ic��io� 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 PROJECT SITE INFORMATION PROJECT ADDRESS: �%�.� � l j-; - I:' l�`(� �� f<� ��`—'._ I.�./ . �:�'�. - � IF APPLICABLE: ❑ OUTSIDE CITY LIl�fN�S ❑ BUILDING AREA � SF ❑ LOT# BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED �ULEX ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL ❑INDUSTRIAL CHANGE OF USE? ❑ NO YES, FROM �L � � - 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 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: qnn ppTtnlG TO INSTALL MULTIPLE DOMESTIC WATER ❑ FIRE: 1", 2", 4", 6", 8", OTHER: SERVICES FOR MY MULTI-FAMILY DEVELOPMENT UNDER ❑ DOMESTIClFIRE COMBO: 1", 2", OTHER: SINGLE OWNERSHIP. FILL OUT REVERSE SIDE OF THIS FORM. CONTACT INFORMATION OWNER NAME: �� iG� 1 �' i{f��f� � �'�`l � �� TENANT NAME(If Commercial): � � OWNER MAILING ADDRESS: srReEr G( �'^�__ ��n �=✓�� r��.��t— sTATE � �. � Z�P `��:�r OWNER PHONE: `��"�7 �' �-� � _ �'�� ; OWNER EMAIL: C� IG"t I�� J�Y��L'V�� ' z �- :' .C- �' CONTRACTOR NAME: CONTRACTOR ADDRESS: sTrteEr CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): PRIMARY CONTACT: C�'�OWNER ❑ CONTRACTOR ❑ OTHER(Please Specify) CONTAC NAME: CONTACT PHONE: � �'' ��"-� �" ._ - ` CONTACT EMAIL: a C- �� %��.. r/'��1 j e6� v�%j�1 � �� L �.ct r ti�1� � � r Gt, 1 Cc AGREEMENT:The undersigned applicant agrees to comply with all provisions of the Everett Municipal Code Title City of Everet Officia/Use Only 94 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�ighf at any time, without notice,to shut off or turn on the water supply for repairs,construcfion,and nonpaymen �f charges or for any other reasonable cause.l am the owner, or I am authorized by the owner of this pr t p'erform fhe work for whisl�applicatron is made,and I comply with the State Contractors Law 18.27 PERMIT# CVl/� n 296.200A WAC. ` /f j�� / � � �� ' =��'��t, � �� J ; � 'er/Authorized Agent Signature Date (Revised 10/92/2015)