7812 19TH DR SE 2018-02-27 - Laserfiche WebLink

"111.44 - MIER I SEWER UTILITYTPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 I FAX 425-257-8857 I (E) everetteps@everettwa.gov J www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 19TH DR SE EVERETT WA 98204 IF APPLICABLE: 0 OUTSIDE CITY LIMITS 0 BUILDING AREA 2435 SF ❑ LOT / BUILDING TYPE: ® SFR 0 MULTI-FAMILY 0 COMMERCIAL ❑ INDUSTRIAL CHANGE OF USE? X2 NO 0 YES, FROM TO UTILITY APPLICATION INFORMATION SEWER(check all that apply) WATER(check all that apply) ❑ SIDE SEWER REPAIR ®NEW WATER SERVICE INSTALLATION ❑SIDE SEWER ALTERATION 0 COMPLETE SERVICE '1 METER ONLY ® NEW SIDE SEWER INSTALLATION SERVICE/METER USE: ❑INSTALL BACKWATER VALVE(outside the building) 1 SFR ❑SIDE SEWER CAP OFF ❑ MULTI-FAMILY-#OF UNITS: 0 SIDE SEWER RECONNECTION 0 COMMERCIAL MULTIPLE DOMESTIC WATER SERVICES REQUEST WATER SERVICE TYPE/SIZE:(circle desired size) ❑ IAM 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: ❑ I AM OPTING TO INSTALL MULTIPLE DOMESTIC WATER 0 FIRE: ® 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 FORM. CONTACT INFORMATION OWNER NAME:ALPINE HEIGHTS LLC TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET 120 SW EVERETT MALL WAY SUITE 100 cnv 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 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): PRIMARY CONTACT: ❑OWNER M CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: STEVE SNYDER CONTACT PHONE:425-319-0122 CONTACT EMAIL: STEVE.S@SEAPACHOMES.COM ;GREEMENT 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 tie right at any time,without notice,to shut off or turn on the water supply for repairs,construction,and `/'��^/_ D 'onpayme . of charge or for any other reasonable cause,lam the owner,or l am authorized by the owner of this •`�'O/ roperty to erform the ork for which application is made,and f comply with the State Contractors Law 18.27 'CWa d 98.>00A PERMIT#• r '• U 1�e�2—D2(v 4-5-16 )wner!Authorized Ag t Signature Date (Revised 09/25/2015)