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Wi,nrER I SEWER UTILITY •'PLICATION <br /> /11P-0.47A <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: ��� <br /> 9TH DR SE EVERETT WA 98204 <br /> IF APPLICABLE: 0 OUTSIDE CITY LIMITS ❑ BUILDING AREA S'5'/.f/pa.` SF ❑ LOT# <br /> BUILDING TYPE: ®SFR 0 MULTI-FAMILY 0 COMMERCIAL 0 INDUSTRIAL <br /> CHANGE OF USE? r$NO ❑YES, FROM TO <br /> UTILITY APPLICATION INFORMATION <br /> SEWER(check all that apply) WATER(check all that apply) <br /> ❑ SIDE SEWER REPAIR <br /> Ea NEW WATER SERVICE INSTALLATION <br /> ❑SIDE SEWER ALTERATION 0 COMPLETE SERVICE E METER ONLY <br /> ►4 NEW SIDE SEWER INSTALLATION SERVICE/METER USE: <br /> 0 INSTALL BACKWATER VALVE(outside the building) giCSFR <br /> ❑SIDE SEWER CAP OFF 0 MULTI-FAMILY-#OF UNITS: <br /> 0 SIDE SEWER RECONNECTION 0 COMMERCIAL <br /> MULTIPLE DOMESTIC WATER SERVICES REQUEST WATER SERVICE TYPE/SIZE:(circle desired size) <br /> 0 I AM DECLINING MULTIPLE DOMESTIC WATER SERVICES FOR ❑DOMESTIC: 3/4", 1", 2", OTHER: <br /> MY MULTI-FAMILY DEVELOPMENT UNDER SINGLE OWNERSHIP. 0 IRRIGATION: 3/4", 1", 2", OTHER: <br /> 0 I AM OPTING TO INSTALL MULTIPLE DOMESTIC WATER 0 FIRE: ®r 2", 4", 6", 8", OTHER: <br /> SERVICES FOR MY MULTI-FAMILY DEVELOPMENT UNDER <br /> ®DOMESTIC/FIRE COMBO: 1", 2", OTHER: <br /> SINGLE OWNERSHIP. FILL OUT REVERSE SIDE OF THIS FORM. <br /> CONTACT INFORMATION <br /> OWNER NAME:ALPINE HEIGHTS LLC TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 120 SW EVERETT MALL WAY SUITE 100 <br /> • cm, EVERETT STATE WA ZIP 98204 <br /> OWNER PHONE: 360-953-2800 !OWNER EMAIL: WWW.SEAPACHOMES.COM <br /> CONTRACTOR NAME: SEA PAC HOMES <br /> CONTRACTOR ADDRESS: STREET 120 SW EVERETTT MALL WAY SUITE 100 <br /> crrr EVERETT STATE WA ZIP 98204 <br /> CONTRACTOR PHONE 360-953-2800 !CONTRACTOR EMAIL: WWW.SEAPACHOMES.COM <br /> CONTRACTOR LICENSE#(REQUI RED): 'CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER ®CONTRACTOR 0 OTHER(Please Specify) • <br /> CONTACT NAME: STEVE SNYDER CONTACT PHONE:425-319-0122 <br /> CONTACT EMAIL: STEVE.S@SEAPACHOMES.COM <br /> 3GREEMENT:The undersigned applicant agrees to comply with all provisions of the Everett Municipal Code Title <br /> '4 Water and Sewer or such other rules and regulations now existing or which may be established from time to COY of Everett Official Use Only <br /> 'me. The applicant further agrees,as a condition precedent to receiving service that the utilities division shall have FEE �( 55012.0° <br /> ;e right at any time,without notice,to shut off or turn on the water supply for repairs,construction,and r Q L <br /> .enpayme of charge or for any other reasonable cause.lam the owner,or 1 am authorized by the owner of this `rl <br /> •r operty to erform th e ork for which application is made,and 1 comply with the State Contractors Law 18.27 <br /> ?CW and 96.'OOA . ,PERMIT <br /> n# <br /> t, , ►i 4-5-16 V 1 U! 11 O11 <br /> )wner/Authorized Ag: t Signature Date <br /> (Revised 09/25/2015) <br />