2605 GRAND AVE 2018-01-18 - Laserfiche WebLink

�� o �� o�o�� p�o�a�oo�� � 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 ��dC��1 ��5i� Of��I�G'��1�1�0�� PROJEC7'ADDRESS: Z O IF�.PPLICABLE: ❑ OUTSID�CITY LIMITS ❑ BUILDING AREA SF ❑ LOT# BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑DULEX ❑MULTI-FAMILY�#OF UNITS: ❑COMMERCIAL ❑INDUSTRIAL CNANGE OF U5E? NO ❑ YES, FROM TO NJ`��1�.05i'lY W��O�L�`�'0�� 01��'oOl�fi�i W�D�G�9 SEWER(check all that apply) �I/A7ER(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 BACKVI/ATER VALVE(outside the building) ❑ SFR ❑ SIDE SEWER CAP-OFF ❑ MULTI-FAMILY-#OF UNITS: ❑ SIDE SEWER RECONNECTION ❑ COMMERCIAL MULTIPLE DOfVIESTIC WATER SERVICES REQUES7 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 Uf�DER ❑ DOMESTIC/FIRE COMBO: 1", 2", OTHER: SINGLE OWNERSHIP. F/LL OUT REVERSE SIDE OF THIS FORM. CO�e1T'�#CT 9BdFORMA'I'ION OWNER NAIVIE: TEPVAPIT iVAME(If Commercial): OWiJER IVIAILIPdG ADDRESS: srHE�T C17Y STATE Z�P OWNER PHONE: OWPVER EtVIAIL. COiVTRACTOFt iV,4ME: � COYdTRACTOR�4DDRESS: srREer �9� ba��e CITY � STATE � � ZIP �, COPVTRACTOR PHONE: � '� CO TRACTOR EiViAIL: I� e Qj �� o � CONTRACTOR LIC.#(REc�U1RED)v , � �� C17'Y OF EVERETT BUSINE�LIC.#(REQUIRED� � _._... ___,__, _ PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ❑ OTHER(Please Specify) CONTACT NAME� fl CONTACT PHOftIE: �� ; ' �,j �L ,�� �,� $�� `��d� �'��,� COi�ITACT Ef111P,lL: ' � � � � �a o `� AGREEMENT:Tlie undersrgned applicant agrees to comply with all provisions of the F_verett Municipal ode Title � Cify of Ever t Otficial Use Only 94 Water and Sewer or such other rules and regulations now existing or which may be established fi'om time to FEE time. The applicant further agrees, Sra cond�� precedent fo receiving servrce that the utilities division shall have � � Q� the right af any e, w' t notic ,to shut ofr o turn on the v✓ater supply forrepairs,construction, and nonpaymenf f ch r s or or an other reasona le cause_l am the owner,or I am authorized by the ov✓ner of fhis � property to p for he wo ✓hich applicatio is made, and I comply with the Sfate Contractors!_aw 18.7_7 PFRMIT# RCW and 29 200 WAC - .� "� U ��0�� wner/Aufhoriz gent Sig afure Date (I�evised 10/92/?_015)