1523 132ND ST SE ANYTIME FITNESS 2018-03-29

V1 ER / SEWER UTILITY AI LICATION .44 CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 I FAX 425-257-8857 1 (E) everetteps@everettwa.gov www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 2 J I?'�-V r�1 } ` k; vein-c I t INA c-/ j IF APPLICABLE: 0 OUTSIDE CITY LIMITS 0 BUILDING AREA SF 0 LOT# BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ODULEX ❑MULTI-FAMILY-#OF UNITS:_ COMMERCIAL ❑INDUSTRIAL CHANGE OF USE? XINIO 0 YES, FROM TO UTILITY APPLICATION INFORMATION SEWER(check all that apply) WATER(check all that apply) ❑SIDE SEWER REPAIR 0 NEW WATER SERVICE INSTALLATION ❑SIDE SEWER ALTERATION 0 COMPLETE SERVICE IR METER ONLY ❑NEW SIDE SEWER INSTALLATION SERVICE I METER USE: ❑INSTALL BACKWATER VALVE(outside the building) 0 SFR ❑SIDE SEWER CAP-OFF 0 MULTI-FAMILY-#OF UNITS: ❑SIDE SEWER RECONNECTION X7 COMMERCIAL MULTIPLE DOMESTIC WATER SERVICES REQUEST WATER SERVICE TYPE/SIZE: (circle desired size) ❑ I AM DECLINING MULTIPLE DOMESTIC WATER SERVICES FOR E]DOMESTIC: iltip1", 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", 2". OTHER: SINGLE OWNERSHIP. FILL OUT REVERSE SIDE OF THIS FORM. CONTACT INFORMATION OWNER NAME:O t,hwA y'jG i,,y0 t 0y— \ 1 C TENANT NAME(If Commercial): - '- ( ( t+Ut',S S OWNER MAILING ADDRESS:tSTREET ?O ''" 40 9c C ' `l CITY AOC tA. -R 'e.- STATE V\ThZIP CI t0 OWNER PHONE: 4-2r-,—' — 241611 OWNER EMAIL: IIV4cv- e yVt kc-17.. we. CONTRACTOR NAME: Farwest Tenant Improvements Inc. CONTRACTOR ADDRESS: STREET 7710 220th St SW CITY Edmonds STATE WA ZIP 98026 CONTRACTOR PHONE: 206-430-2425 CONTRACTOR EMAIL: holland@farwestti.com CONTRACTOR LIC,#(REQUIRED) 603 405 928 CITY OF EVERETT BUSINESS LIC.#(REQUIRED):055061 PRIMARY CONTACT 0 OWNER !CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 206-930-7649 Brian Benedetti CONTACT EMAIL: brian@farwestti.com AGREEMENT:The undersigned applicant agrees to comply with all provisions of the Everett Municipal Code Title 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 time. The applicant further agrees,as a condition precedent to receiving service that the utilities division shall have FEp) Eethe right at any time,without notice,to shut off or turn on the water supply for repairs,construction,and ( e00 nonpayment of charges or for any other reasonable cause.I am the owner,or I am authorized by the owner of this property to perform the work for which application is made,and I comply with the State Contractors Law 18.27 PERMIT# RCW and 296.200A WA U ( O f Own nixed Agent Slnatur Date (Revised 10/12/2015)