2401 BROADWAY 2018-04-19 - Laserfiche WebLink

�.`��R 1 �� `�eLl AP�I��,�`�� CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 9820'1 (P)42�-257-8810 � FAX 42�-257-8857 � (E)everetteps@everef[wa.gov� www.everettwa.govlpermits .. _ _ . , ; PROJEC7° Sli'E IIdF�R11liA`t'I�N . . .. _ . __ _. . _. _ . . _ _ . .. . _ . . .. PROJECT ADQRESS: t � j /�� i9/7 Gd� tiI �UL:�C TT- G(J� g� 2-�� IP APPLICABLE: ❑OUTSIDE C1TY LIMITS Ll BUiLDWG AREA �J�� SF ❑ LOT# BUILDING TYPE: ❑SFR-DETACHED ❑SFR ATTACHED ❑DULEX ❑MULTI-FAMILY-#OF UNITS: COMMERCIAL ❑INDUSTRIAL CHANCE OF USE? �NO ❑YES, FROM TO ,.. -, : .. . _ ' UTiLITIf APPI�IC,A7'IOId INFORMATION - SEWER(check all that apply} WATER{check all that apply) �SIDE SEWER REPAIR ❑NEW WATER SERVICE INSTALLATION ❑S1DE SEUVER ALTERATION ❑ COMPLETE SERVtCE ❑METER ONLY ❑ NEW SIDE SEWER INSTALLATION SERVICE/METER USE: ❑ INSTALL BACKWATER VALVE(outside the buiiding) ❑SFR ❑SIDE SEWER CAP-OFF ❑MULTI-FAMILY-#OF UNITS: E ONNECTION ❑COMMERCIAL MULTiPLE DOMESTIG WATER SERV[CES REQUEST WATER SERVICE TYPE/SIZE:(circle desired size) C� I AM DFCLINING MULTIPLE DOMESTIC WATER SERVIGES FOR ❑DOMESTIC: 3/4", 9", 2", OTHER: MY MULTI-FAMILY DEVELOPMENT UNDER SINGLE OWNERSHIP. ❑)RRIGATION: 3/4", 1", 2", OTHER: ❑ I AM OPTING TO INSTALL MULTIPLE DOMESTIC WATER ❑FIRE: 1", 2", 4", 6", 8", OTHER: SERVICES FOR MY MULTI-FAMILY DEVELOPMENT UNDER ❑pOMESTIC/FIRE COMBO: 1", 2", OTHER: SINGLE OWNERSHIP.F/LL OUT REi/ERSE 51DE OF THIS FORM. .... , : . . . . - _ . ... . .. . ... . . ,. . . CONTACT. INFORMi4TiON . � : `-: _ . . .. _ ._.. ,... ......_. .. . . OWNER NAME: Z �/D 1 /.S/`D��W�* }� � �'C TENANT NAME(If Commercial): OWNER MAILING ADDRESS: s-rR�r � L/ � jY1 R PG � /� I�L� crrv S A/� ��os'!�1 1 S t/ srn� /�l�/4" ziP g�z 9 d OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: �� o G��s T,.e- v e�'�o� �o�P � � -. ,��5� �L B CONTRACTOR ADDRESS; sraEEr CITY STATE ZIP CONTRACTOR PHONE: COtVTRAGTOR EMAIL: CONTRACTOR LIG.#(REG2UIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): PRIMARY CONTACT: ❑OWNER Cl CONTRACTOR ❑OTHER(Please Specify) COIVTACT NAME: ��N �`c�/j/f{ CONTACT PHONE: � � �' � y? �Z Z 9 2� CONTACT EMAIL: �Q h � � a re se� 17`le � c��'l AGREEMENT.•The undersigned applicant agrees to compiy with a/!provisions of the Evereit Municipa!Code Title City of Evereft Official Use Only 94 Water and Sewer or such other rules and regulafions now existing or which may be established from time to FEE /9/1 time_The applicant further agrees,as a condifion precedent to receiving service ihat the uiilities division shall have W the righf af any fime,without nofice,to shut off or turn on fhe water supply for repairs,construction,and � � nonpaymenf of charges or for any other reasonab/e cause.l am the owner,or 1 am authorized by the owner of this property fo pertorm the work for which application is made,and I comply with the State Contracfors Law 98.27 PERM IT RCVi�and 296.200A WAC. 1 � � �^' �� .� �-��PJ�'1 J � ��" Tl� G Owner/Authorized Agent Signature Date (Revised 90/92/2015)