7810 19TH DR SE 2018-02-27 - Laserfiche WebLink

WATER I SEWER UTILITY tPPLICATION fir' CITY OF EVERETT PERMIT SERVICES 7� 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 I FAX 425-257-8857 I (E) everetteps@everettwa.gav I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECTADDRESS: 19TH DR SE EVERETT WA 98204 IF APPLICABLE: Q OUTSIDE CITY LIMITS 0 BUILDING AREA 213 ;p/t, SF ❑ LOT# -� BUILDING TYPE: IXI SFR 0 MULTI-FAMILY 0 COMMERCIAL 0 INDUSTRIAL CHANGE OF USE? U NO 0 YES, FROM TO UTILITY APPLICATION INFORMATION SEWER (check all that apply) WATER(check all that apply) ❑ SIDE SEWER REPAIR in NEW WATER SERVICE INSTALLATION ❑SIDE SEWER ALTERATION 0 COMPLETE SERVICE El METER ONLY El NEW SIDE SEWER INSTALLATION SERVICE/METER USE: ❑ INSTALL BACKWATER VALVE(outside the building) SFR ❑SIDE SEWER CAP OFF 0 MULTI-FAMILY-#OF UNITS: ❑ SIDE SEWER RECONNECTION ❑COMMERCIAL MULTIPLE DOMESTIC WATER SERVICES REQUEST 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. 0 IRRIGATION: 3/4", 1", 2", OTHER: 0 I AM OPTING TO INSTALL MULTIPLE DOMESTIC WATER 0 FIRE: 1", 2", 4", 6", 8", OTHER: SERVICES FOR MY MULTI-FAMILY DEVELOPMENT UNDER Ill DOMESTIC/FIRE COMBO: 1", 2", OTHER: SINGLE OWNERSHIP.FILL OUT REVERSE SIDE OF THIS FORM. CONTACT INFORMATION OWNER NAME:ALPINE HEIGHTS LLC TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET 120 SW EVERETT MALL WAY SUITE 100 cm,' EVERETT STATE WA ZIP 98204 OWNER PHONE: 360-953-2800 !OWNER EMAIL: WWW.SEAPACHOMES.COM CONTRACTOR NAME: SEA PAC HOMES CONTRACTOR ADDRESS: sTR=ET 120 SW EVERETTT MALL WAY SUITE 100 crry EVERETT STATE WA ZIP 98204 CONTRACTOR PHONE 360-953-2800 !CONTRACTOR EMAIL: WWW.SEAPACHOMES.COM CONTRACTOR LICENSE#(REQUIRED): 'CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 'RIMARY CONTACT: 0 OWNER EI CONTRACTOR ❑OTHER(Please Specify) :'ONTACT NAME: STEVE SNYDER CONTACT PHONE: 425-319-0122 CONTACT EMAIL: STEVE.S@SEAPACHOMES.COM 4GREEIdENT. The undersigned applicant agrees to comply with all provisions of the Everett Municipal Code Title 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 time,without notice,to shut off or turn on the water supply for repairs,construction,and g M v, 0� onpayme of charge or for any other reasonable cause.I am the owner,ort am authorized by the owner of this roperty to .erform th:t ork for which application is made,and I comply with the State Contractors Law 18.27 'CW e d 98. '00A r _ PERMIT# 1 4-5-16 V l `i b�j- 02.5 weer/Authorized Ag= t Signature Date (Revised 09/25/2015)