2515 WETMORE AVE 2018-01-19 - Laserfiche WebLink

�� o �� o�o�� p�o�a�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 lPfp3��1�C�il' ��i�� D�I�oOfR�'liQ��IR� PROJECT ADDRESS: � IF APPLfCABLE: ❑ OUTSIDE CITY LIMITS ❑ BUILDING AREA SF ❑ LOT# BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑DULEX ❑MULTI-FAMILY-�#OF UNITS: ❑COMMERCIAL ❑INDUSTRIAL CNAiVGE OF U5E? NO ❑ YES, FROM TO M�0�,0`�l`�La��'dOC�L�`tY0�6J ��G�i�.1`�P�oOL� SEWE�(check all that apply) liVA'i'�R(check all that apply) ❑ SIDE SEWER REPAIR ❑ I�iEW 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 DOMES'TIC WATER SERVICES REQUEST WATER SERVICE 7YPE/S1ZE: (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 THIS FORNI. C�rd"��lC'�' 9BdF09�MA�oORI OWNER NANIE: TEPVAPdT P1AME(If Commercial): OWNER MAILIIVG ADDRESS: srREET CITY S7ATF ZIP OWNER PHOIVE: OVVPVER EMAIL: COi�TR.�CTOR WAME: COP�ITRAC70R.4DDRESS: srReer �° �q �� CITY � STATE �� o ZIP � � COPdTRACTOR PHONE:�yj � � COftITR�,CTOR Ei�AIL: 'Q ��/ � �� e � COFVTRACTOR LIC.#(RECIUIRED)o ,�j � � � C17Y OF EVERETT BUSINE� LIG#{REQUIRED� � PRIMARY COIVTACT: ❑OWNER ❑ CONTRACTOR ❑ OTHER(Piease Specify) C0IVTACT IVAME� w COIVTACT PhiOME: �� , L'J� �� �� l�'��6� ��G11� a co�v�rAc�r��nsa�t: C � � ` !/�1�/ � 0 AGREEMENT:Tl�e emdersigned applicanf agrees to comply with all provisions of the .F_vereft Municipal ode Title � Cify of Ever t Officia!Use Only 14 Water and Sewer or such other rules and regulations now existing or which may be esfablisl�ed f�om time to �EE time. The applicant fi�rther agrees, S�a cond�' precedent to receiving servrce that fhe utilities divrsion shall have the�ighf at any � e, w' t notic , to shut off o turn on fhe water supply for repai�s,const�uction,and �� nonpayment f ch r s or or an other reasona le cause.I am ihe owner, or I am authorized by the otvner of fhis property to p or he wo c ✓hich applicatio is made,and I comply tvifh the State Contractors Law 18.27 PERMII # RCW and 29 200 WAC _ ��__ % � I�l 0� - o�� wnerlAuthoriz gent Sig afure Date (Revised 90/92/2095)