3324 GRAND AVE 2018-05-01 - Laserfiche WebLink

�9i Q�L� � ��n��3 M`�OLO�� ap�'f��0�� CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 � FAX 425-257-8857 � (E) everetteps@everettwa.gov � www.everettwa_gov/permits . PRO.1�C'i' SI I('� I��RIVie�`�1��9 PROJECT ADDRESS: �� Z C- �� ^ 1F APPL(CABLE: ❑ OUTSIDE CITY LIMITS ❑ BUILDING AREA SF ❑ LOT# BUlLDING TYPE: FR-DETACHED ❑SFR-ATTACHED ❑DULEX ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL ❑INDUSTRIAL CHANGE OF USE? � ❑YES, FROM TO �D`�IL17`Y AP�L�CA`�"101�➢ 18�lFORMA`i'IOI� SEWER(check all that apply) WATER(check all that apply) C'4�-�TbE SEWER REPAIR ❑ NEW WATER SERVICE INSTALLATION ❑ SIDE SEWER ALTERATION ❑ COMPLETE SERVICE ❑ METER ONLY ❑ NEW SIDE SEWER INSTALLATION SERVICE/METER USE: ❑ INSTALL BACKWATER VALVE(outside fhe building) ❑SFR ❑ 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 ❑ DOMESTIC: 3/4", 1", 2", OTHER: MY MULTI-FAMILY DEVELOPMENT UNDER SINGLE OWNERSHIP. ❑ IRRfGATION: 3/4", 1", 2", OTHEf2: ❑ I AM OPTING TO INSTALL MULTIPLE DOMESTIC WATER ❑ FIRE: 1", 2", 4", 6", 8", OTHER: SERVICES FOR MY MULTi-FAMILY DEVELOPMENT UNDER ❑ DOMESTIC/FIRE COMBO: 1", 2", OTHER: SINGLE OWNERSHIP_ F/LL OUT REVERSE SIDE OF THIS FORM. CONTACT INFORMATION OWNER NAME: ' � � ' �� TENANT NAME(If Commercial): OWNER MAILING ADDRESS: srREeT 3 � � �� CITY ��T�—<<-�'" � � STATE �V-�— ZIP OWNER PHONE: OWNER EMAIL: .W�.. .�,� a:... ,.:....._.,.,,., , ..._,.� ,..�. . ......,...�.,.,...... ... .,.: ,.<,,.�,_. .,..,.... . ..��_ .. �...,_ ..,_ ... � CONTRACTOR NAME: �Z'�Gl��' ��T�"��r�� CONTRACTOR ADDRESS: srReer � l � cirr c'3 . CGti(!S�� STATE ZIP � � L(�J CONTRACTOR PHONE: � ZS� (Z3 �' CONTRACTOR EMAIL: �"'� ��(�'i`�� ' �T��-f° �� CONTRACTOR LIC.#(REQUIRED): S�.I/L��--�� '�� CITY OF EVERETT BUSINESS LIC #(REQUIRED): PRIMARY CONTACT:�nl�OWNERI ,L7 CONTRACTOR ❑ OTHER(Please Specify) CONTACT NAME: \'�� COfVTACT PHONE: Z 5 1 Z� S/c�� COiVTACT EMAIL: G �2E�v�f:7r�cr�?i.�-� � �—�'►-1 AGREEMENT.'The undersigned applicant agrees fo comply with all provisions of the Evereff Municipal Code Title City of Everett Official Use On/y 14 Water and Sewer or such ofher rules and regulations now existing or which may be established from time to FEE time. The applicant further ag�ees, as a condition precedenf to receiving service that fhe utilifies division shaU have OO the righf af any time,without notice,to shut off or turn on the water supply forrepairs,consfn�ction,and � �O� nonpayment of charges or for any other reasonable cause.1 am the owner,or l am autf�orized by the owner of this v property to perfor �k for which appiication is made,and I comply with the State Contractors Law 98.27 PERMIT# RCW and 200A W . � �f��/�1� U U` Owner/A rized Signatur _ Date (Revised 90/17J2095)