2316 CEDAR ST 2018-01-18 - Laserfiche WebLink

�� o��i� 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 PROJ�C`� SI`�� ePI�O�MA��i�9 PROJECT,4DDRESS: � � ' IF APPLICABLE: ❑ OUTSIDE CITY LIMITS ❑ BUILDING AREA SF ❑ LOT# BUILDIIVG TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑DULEX ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL ❑INDUSTRIAL CHANGE OF USE? � NO ❑YES, FROM TO UTILI'rY APP�,ICA7'10� Ib��OR9VGl��'BO�i SEWER (check all that apply) WATER(check all that apply) �7 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 ❑ F1RE: 1", 2", 4", 6", 8", OTHER: SERVICES FOR MY MULTI-FAMILY DEVELOPMENT UNDER ❑ DOMESTIC/FIRE COMBO: 1", 2", OTHER: SINGLE OWNERSHIP. FILL OUT REVERSE SIDE OF THlS FORM. CONTACT INFORMATION OWNER NAME: TENAIdT NAME(If Commercial): OWNER MAILING ADDRESS: sTReer CI71' STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR IVAME: CONTRACTOR ADDRESS: sTReET � CITY STATE ZIP CONTRACTOR PHONlE: ' '9 CONTRACTOR EiViAIL: Q � ` CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSIN LIC.#(REQUIRED): � PRIMARY COI�TACT: ❑OWNER ❑ CONTRACTOR ❑ OTHER(Please Specify) CONTACT P1AME: CONTACT PHONE: � �� 'e� �'�° �� �� ,�� GOR�T,ACT EMAIL: � � � � a • AGREEMENT:The undersigned applrcant agrees to comply with aU provisions of the Everett Municipal ode Trtle City of Ever t Official Use Only 94 Water and Sewer or such other rules and regulations now existing or which may be established from time to FEE �, ll � time. The applicant further agrees, as a condition precedent fo receiving service ihat the utilities divrsion shall have � �� O� the right af any fime,without notice, to shut off or turn on fhe water supply for repairs,construction,and nonpayment of charges or for any other reasonaGle cause.I am fhe owner,or I am authorized by the owner of this ° property to perforrr�the work for whrch application,is made,and I comply wifh the Sfate Contracfors Law 18.27 PERMIT# RCW and 296.7_OOA WAC.� � 1� � I I �� wner/Authorized Agent Signature Date (Revised 90/12/?_01,5)