517 ALVERSON BLVD 2018-03-27 - Laserfiche WebLink

WATER ! SEWER UTILITY APPLICATION 4 ' CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 l FAX 425-257-8857 1 (E)everetteps@everettwa.gov l www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 517 ALverson Boulevard Everett WA 98201 IF APPLICABLE: 0 OUTSIDE CITY LIMITS 0 BUILDING AREA SF 0 LOT# BUILDING TYPE: elSFR-DETACHED ❑SFR-ATTACHED ❑DULEX ❑MULTI-FAMILY-#OF UNITS: OCOMMERCIAL ❑INDUSTRIAL CHANGE OF USE? 0 NO 0 YES, FROM TO UTILITY APPLICATION INFORMATION SEWER(check all that apply) WATER(check all that apply) 0 SIDE SEWER REPAIR 0 NEW WATER SERVICE INSTALLATION ❑SIDE SEWER ALTERATION 0 COMPLETE SERVICE 0 METER ONLY ❑NEW SIDE SEWER INSTALLATION SERVICE/METER USE: ❑INSTALL BACKWATER VALVE(outside the building) 0 SFR ❑SIDE SEWER CAP-OFF 0 MULTI-FAMILY-#OF UNITS: ❑SIDE SEWER RECONNECTION 0 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: ❑I AM OPTING TO INSTALL MULTIPLE DOMESTIC WATER 0 FIRE: 1", 2", 4", 6", 8", OTHER: SERVICES FOR MY MULTI-FAMILY DEVELOPMENT UNDER 0 DOMESTIC/FIRE COMBO: 1"b 2", OTHER: SINGLE OWNERSHIP.FILL OUT REVERSE SIDE OF THIS FORM. CONTACT INFORMATION OWNER NAME: ROn Burgner TENANT NAME(If Commercial). OWNER MAILING ADDRESS: STREET 517 Alverson Boulevard c,Everett STATE WA ZIP 98201 OWNER PHONE:425-478-5847 OWNER EMAIL: rOnbUrgner gmall.001T1 CONTRACTOR NAME: Sposari inc, dba Mr. Rooter Plumbing & Heating CONTRACTOR ADDRESS: STREET 2000 South 116th ST CITY Seattle STATE WA ZIP 98168 CONTRACTOR PHONE:206-651-2917 CONTRACTOR EMAIL: charlenel@mrrootersea.com CONTRACTOR LIC.#(REQUIRED):MRROOP*022NE CITY OF EVERETT BUSINESS LIC.#(REQUIRED):038080 PRIMARY CONTACT: 0 OWNER [d CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT`PHONE:206-335-9927 Charlene Lundgren CONTACT EMAIL:charlenel@rnrrootersea.com AGREEMENT:The undersigned applicant agrees to comply with all provisions of the Everett Municipal Code Title 14 Water and Sewer or such other rules and regulations now existing or which maybe established from time to time.The applicant further agrees,as a condition precedent to receiving service that the utilities division shall have the right at any time,without notice,to shut off or turn on the water supply for repairs,construction,and nonpayment of charges or for any other reasonable cause,lam the owner,or I am y the owner of this property to pert"r t the work for which application is made,and f comply with the State Contractors Law 18.27 RCW and 296.200A WAC,,, r City of Everett Official Use Only PER T# u � -o( Ow horized Age Signature Date (Revised 9/23/2016)