3308 MCDOUGALL AVE 2018-11-14 - Laserfiche WebLink

v�� r ��w�� A�i�� ac��vo� CITY OF EVE=RETT PERMIT SERVICES 3200 CEDAR S�TREET, EVERETT, WA 98201 (P) 425-257-8810 � FAX 425-257-8857 � (E) everetteps@everettwa.gov � www.everettwa.gov/permits PROJEC7 SITE IIdFORMAYIAM PROJECTADDRESS. ��' �,� i � ' iF APPLICABLE: ❑ OUTSIDE CITY LIMITS ❑ BUILDING AREA SF ❑ LOT# BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑DULEX. ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL ❑INDUSTRIAL CHANGE OF USE? ❑NO ❑YES, FROM TO UTILITY APPLICATION INFORMATIAN 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: ❑ 51DE SEWER RECONNECTION ❑ COMMERCIAL MULTIPLE DOMESTIC WATER SERVICES REQUEST WATER SERVICE IYPE/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 UNDER ❑ DOMESTIC/FIRE COMBO: 1", 2", OTHER: SINGLE OWNERSHIP. F/LL OUT REVERSE SIDE OF THIS FORM. CONTACT INFORMATION OWNER NAME: TE:NANT NAME(If Commercial): OWNER MAILING ADDRESS: sTReer CITY STATE ZIP OWNER PHONE: OWNER EMAIL: ,_� . .: ._.. _ ._... .._,,.. .. __,..... ..,..., . ,.._.._ . .. . _., ._. . CONTRACTOR NAME: �/ ��L �U� l �i- CONTRACTOR ADDRESS: srREer CITY STATE ZIP CONTRACTOR PHONE: CONTRACT012 EMAIL: CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REc1UIRED): .._. _._..,__.... . ..._� ,... . ....__, PRIMARY CONTACT: ❑OWNER ❑ CONTRACTOR ❑ OTHER(F'lease Specify) CONTACT NAME: CONTACT PHONE: CONTACT EMAIL: AGREEMENT.�The undersigned applicant agrees to comply with all p�ovisions of the Evere tt Municipal Code Tifle Cify of Everett Official Use Only 14 Wafer and Sewer or such other rules and�egulations now existing or which may be establrshed from time fo FEE time. The applicant fu�ther agrees, as a condition precedent to receiving service that the uti�ities division shall have �X�, I,I � . �� the righf at any time,without notice,to shut otf or turn on the wafer supply for repairs,consiruction,and �� nonpayment of charges o�for any other reasonable cause.1 am the owner,or I am authorized�y fhe owner of fhis ' prop y to perfor fhe work for which application is made,and I comply with the Sfate Cortractors Law 98.27 PERMIT# RC OA � � � � ��-�a� OwnerlAuthorized Agent Signature Date (Revised 90/12/2015J