7802 19TH DR SE 2018-02-27 - Laserfiche WebLink

WijER / SEWER UTILITY IF PLICATION N-di __ , CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps 7a everettwagav I www.everettwa.gavfpermits PROJECT SITE INFORMATION PROJECT ADDRESS: 7802-19TH DR SE EVERETT WA 98204 IF APPLICABLE: Q OUTSIDE CITY LIMITS ❑ BUILDING AREA 2435 SF ❑LOT# 20 BUILDING TYPE: El SFR 0 MULTI-FAMILY 0 COMMERCIAL ❑INDUSTRIAL CHANGE OF,USE? f NO 0 YES, FROM TO UTILITY APPLICATION INFORMATION SEWER(check all that apply) WATER(check all that apply) 0 SIDE SEWER REPAIR ®NEW WATER SERVICE INSTALLATION 0 SIDE SEWER ALTERATION 0 COMPLETE SERVICE El METER ONLY El NEW SIDE SEWER INSTALLATION SERVICE/METER USE: 0 INSTALL BACKWATER VALVE(outside the building) USER ❑SIDE SEWER CAP-OFF 0 MULTI-FAMILY-#OF UNITS: ©SIDE SEWER RECONNECTION 0 COMMERCIAL MULTIPLE DOMESTIC WATER SERVICES REQUEST WATER SERVICE TYPE I SIZE:(circle desired size) ©I AM DECLINING MULTIPLE DOMESTIC WATER SERVICES FOR Q DOMESTIC: 3/4", 1", 2", OTHER: MY MULTI-FAMILY DEVELOPMENT UNDER SINGLE OWNERSHIP. 0 IRRIGATION: 3/4", 1", 2", OTHER: ©1 AM OPTING TO INSTALL MULTIPLE DOMESTIC WATER 0 FIRE: 1", 2", 4", 6", 8", OTHER: SERVICES FOR MY MULTI-FAMILY DEVELOPMENT UNDER in SINGLE OWNERSHIP.FILL OUT REVERSE SIDE OF THIS FORM. DOMESTIC/FIRE COMBO: 1", 2", OTHER: CONTACT INFORMATION OWNER NAME:ALPINE HEIGHTS LLC TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET 120 SW EVERETT MALL WAY SUITE 100 env EVERETT STATE WA zip 98204 OWNER PHONE: 360-953-2800 OWNER EMAIL: WWW.SEAPACHOMES.COM CONTRACTOR NAME: SEA PAC HOMES CONTRACTOR ADDRESS: STREET 120 SW EVERETTT MALL WAY SUITE 100 cn-Y EVERETT STATE WA zip 98204 CONTRACTOR PHONE 360-953-2800 !CONTRACTOR EMAIL: WWW.SEAPACHOMES.COM CONTRACTOR LICENSE#(REQUIRED): 'CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: ❑OWNER ®CONTRACTOR 0'OTHER(Please Specify) :. :_. .. ..,, _., .__ ...., ........ CONTACT NAME: STEVE SNYDER CONTACT PHONE:425-319-0122 CONTACT EMAIL: STEVE.S@SEAPACHOMES.COM 3GREEMENT•The undersigned applicant agrees to comply with all provisions of the Everett Municipal Code 77tle '4 Water and Sewer or such other rules and regulations now existing or which may be established from time to City of Everett Official Use Only me. The applicant further agrees,as a condition precedent to receiving service that the utilities division shall have FEE `le right at any lime,without notice,to shut off or turn on the water supply for repairs,construction,and t 0 511D i).‘ 'onpayme of charge or for any other reasonable cause.lam the owner,or I am authorized by the owner of this roperty toperform th.0 ork for which application is made,and t comply with the Stale Contractors Law 18:27 d :CWa 96.•00A i . Iu , Vlo1i PERMIT#d4-5-16 )wnerlAuthorized Ag: t Signature Date (Revised 09125/2015)