3709 FEDERAL AVE 2018-01-18 - Laserfiche WebLink

��Q��. � ��. �1�'0�� ap��Q�O�� 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 ��o��r s�� o��n��°��r �P PROJECT ADDRESS: � �� G�/�� 1F APPLICA6LE: ❑ OUTSIDE CITY LIMITS ❑ BUILQING AREA SF ❑ LOT# BUILDfNG TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑DULEX ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL ❑INDUSTRIAL CHANGE OF USE? � N� ❑YES, FROM TO u�r��i�rv ��ac��-oor� rn��o�m��-so� SEWER(check all that apply) WATER(check all that apply) .�7 SIDE SEWER REPAIR ❑ NEW WATER SERVICE INSTALLATION ❑ SIDE SEWERALTERATION ❑ COMPLETE 5ERVICE ❑ METER ONLY ❑ NEW 51DE SEWER INSTALLATION SERVICE/METER USE: ❑ INSTALL BACKVVATER 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. ❑ �RRIGATION: 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 SID,E OF THIS FORM. CONTACT INFORMATION �r �` OWNER NAME: ,� //� � TENANT NAME(If Commercial): OWNER MAILING ADDRESS: srREer , U . /� ��-� CITY �i/`� � STATE • ZIP � E'��j OWNER PHONE: OWIdER EMAIL• ,,._.��,.., .. , .._...._ ., --...._ ,.....� .. ,..��. ,... � CONTRACTOR NAME: ��/2(/GU �/ � � CONTRACTOR ADDRESS: sTrzEEr C�.�, STATE Z�P CONTRACTOR PH�NE: COfVTRACTOR EMAIL: �� C��'='L� CQ/�'7 CONTRACTOR L1C.#(REQUIRED): CITY OF EVERETT BUSINESS LIC #(REQUIRED):�� C�S ......,_..�._,,.,.�_�_.: ....,.m... . ...... __.� ,....�„ . ....... ._. .A., PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ❑ OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: CO�ITACT EMAIL: AGREEMENT.'The undersigned applicant agrees to comply with all provisions of the Everett Municipal Code Title City of Everett Offcial Use Only 94 Water and Sewer or such ofher rules and regulations now existing or which may be estab/ished from time to FEE � time.The applicanf further agrees, as a condition precedent to receivinq service that flie utilrfies division shall have ,�,} //�� the righf af any time,without notice,fo shut off or tum on fhe water supply for repairs,construction, and �� nonpaymenf of charges or for any other reasonable cause.1 am the owner,or I am authorized by the owner of this property to perfo�m fhe work for'which application is made,and I comply with fhe State Contractors Law 18.27 PERMIT# �RCW and o0A W 7 � �� � �,��- /l-i✓� '/ � -�- Owner/Authorized Agent Siynature Date (Revised�0/12/2095)