6422 CADY RD 2018-04-30 - Laserfiche WebLink

.. ��. , �� 1�� .�� CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STRE�T, EVERETT,WA 98201 (P)425-257-8810 � F'AX 425-257-8857 � (E) everetteps@everettwa.gov� www.everetfinra.gov/permits � _ � �� PROJ�C7' Sl�'E IIdFAltMi�T10W; 3„ .,s-�, "; ' 4. �� ; ,«: ��<<: .,,.__, _ _;..�_ PROJECT ADDRESS: ✓� ��D 1F APPLICABLE: ❑OUTSIDE CITY LIMITS CI BUILQING AREA SF ❑ LOT# BUILDING TYPE: ❑SFR-DETAGHED ❑SFR-ATTACHED ❑DULEX ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL ❑INDUSTRIAL CHANC�OF USE? �NO ❑YES, FROM TO � ,�.. . . _,. � : „ � - , :-� <: _ . , IJTiL1TY APPLICATION INFOIZMATION ., - - ,:;_ .. . -.:: . . _, : .:.:.... .... ..: ��... :. � .. . � �., _ .. . .._...,. SEWER(check all tha#apply) WATER(check all that apply) SIDE SEWER REPAIR ❑NEW WATER SERVICE INSTALLATION ❑51DE SEWER ALTERATION ❑COMPLETE SERVICE ❑METER ONLY • L7 NEW SIDE SEWER INSTALLATION SER�lICE/METER USE: ❑ INSTALL BACKWATER VALVE outside the building) ❑SFR ❑ SIDE SEWER CAP-OFF ❑MULTI-FAMILY-#OF UNITS: ❑ SIDE SEWER RECONNECTION . ❑COMMERCIAL MULTIPLE DOMESTIC WATER SERVICES REQUEST WATER SERVICE TYPE 1 SIZE: (circie desired size} ❑ I AM DECLINING MULTIPLE DOMESTIC WATER SERVICES FOR ❑ DOMESTIC: 3/4", 1", 2", OTHER_ MY MULTI-FAMILY DEVELOPMENT UNDER SINGLE OWNERSHIP. ❑ �RR[GATION: 3!4", 1", 2", OTHER: ❑ i AM OPTING TO INSTALL MULTIPLE DOMESTIC WATER ❑ F1RE: 1", 2", 4", 6", 8", OTHER: SERVICES FOR MY MULTI-FAMILY DEVELOPMENT UNDER ❑ DOMESTIC/FIRE COMBO: 9", 2", OTHER: SINGLE OWNERSHIP. FILL OUT REVERSE S/DE OF THIS FORM, ,.., ,_ .. . _ -� • � . .F - CONTACT. INFOR:MATI,ON _ OWNER NAME• �% TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET 7�� c� CITY .� /G STATE Z1P /J�� OWNER PHONE: ,Z � —D�J� OWNER EMAIL: 1�-�� rfG'�. GZI �G� CONTRA.CTOR NAME: COIVTRACTOR ADDRESS: STREET cirr STATE �P CONTRACTOR PHONE: CONTRACT�R EMAIL: CONTRACi'�R LIC.#(REQUlRED)' C17'Y OF EVERETT BUSII�IESS L(C.#(REQUIRED): � PRIMARY CONTAGT: �OWNER X ❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTAC7 PHOME: ��3��Q j� �ttr�T- �l�- CONTACT EMAIL: �I��/^1'��"_� li�I1C �L►l �C� AGREEMENT.�The undersigned applicanf agrees to comply with all provisions of the Evereff Municipal Code Tifle City of Everett Offcial Us�Only 94 Vl/afer 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 fhat the utilities division sha!!have •�_ the right at any time,without notice,to shut off or furn on the water supply forrepairs,construction,and nonpayment of charges or for any otherreasonable cause.1 am fhe owner,or I am authorized by the owner of this prope�o perform fhe work for which appiication is made,and l comply with the State Contractors Law 98.27 pERMIT# /R'L'�Wand2 OOA�ACJ �� ` �� /� 1 r � �r n �� Owner/Aufhorized Agent Si ure D fe (Revised 90/1?J2015)