1905 78TH PL SE 2018-03-28 - Laserfiche WebLink

#11W WAR / SEWER UTILITY ALLIGATION + 11 CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 I FAX 425-257-8857 f (E)everetteps@everettwa.gov J www.everettwa,gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 1905-78TH PL SE EVERETT WA 98204 IF APPLICABLE: 0 OUTSIDE CITY LIMITS 0 BUiLDING AREA 1816 SF Q LOT# 17 BUILDING TYPE: El SFR 0 MULTI-FAMILY ❑COMMERCIAL 0 INDUSTRIAL CHANGE OF USE? XS NO ❑YES, FROM TO UTILITY APPLICATION INFORMATION SEWER(check all that apply) WATER(check all that apply) Q"SIDE SEWER REPAIR ®NEW WATER SERVICE INSTALLATION 0 SIDE SEWER ALTERATION ©COMPLETE SERVICE El METER ONLY Ei NEW SIDE SEWER INSTALLATION SERVICE/METER USE: Q INSTALL BACKWATER VALVE(outside the building) gASFR D SIDE SEWER CAP-OFF ❑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 0 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 ISI 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: STREET 120 SW EVERETTT MALL WAY SUITE 100 cmr 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: 0 OWNER l CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: STEVE SNYDER CONTACT PHONE:425-319-0122 CONTACT EMAIL: STEVE.S@SEAPACHOMES.COM AGREEMENT-The undersigned applicant agrees to comply with a!!provisions of the Everett Municipal Code 77tle City of Everett Official Use Only 14 Water and Sewer or such other rules and regulations now existing or which may be established from time to FEE time.The applicant further agrees,as a condition precedent to receiving service that the utilities division shall have 1t the right at any time,without notice,to shut off or turn on the water supply for repairs,construction,and RW0 nonpayme of charge or for any other reasonable cause.lam the owner,or l am authorized by the owner of this property t.1,•rform the .rk for which application is made,and!comply with the State Contractors Law 18.27 PERMIT# RCWa d 36.'ODA 4-5-16 U (0t1 Owner/Authorized Ag- t Signature Date (Revised 09/25/2015)