2016 BAKER AVE 2018-05-14 - Laserfiche WebLink

� /' � �� R�� 9 ��'� � � '��1.��,a � CITY OF EVERETT PERMIT SE S 3200 CEDAR STREET, EVERETT, WA 98209 (P)425-257-8810 � FAX 425-257-8857 � (E)everefiteps@everettwa.gov� www,evereftwa.gov/permits ,t _ �-�_,, � ,�._ - . .. , �, JECT SITE INFORMATION . � � PRO_ � ; �� PROJECT ADDRESS: �j (o � �e�. IF APPLtCABLE: ❑OUTSIDE CITY LIMITS ❑ BUILDING AREA SF ❑ LOT# BU1LDlNG TYPE: FR-DETACHED ❑SFR-ATTACHED �DULEX ❑MULTI-FAMILY#OF UNITS: ❑COMMERCIAL ❑INDUSTRIAL CHANGE OF USE? N� ❑YES, FROM TO ,: _ _. _ . � : ' UTILITY APPLICATION INFORMATION ' SEWER(check all that apply) WATER(check all that apply) �SIDE SEWER REPAIR ❑NEW WATER SERVICE INSTALLATION ❑ SIDE SEWER ALTERATION ❑COMPLETE SERVICE ❑METER ONLY ❑ NEW SIDE SEWER INSTALLATION SERVICE/METER USE: ❑ INSTALL BACKV+/ATER VALVE(outside the building) ❑SFR ❑ SIDE SEWER CAP-OFF ❑MULTI-FAMtLY-#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. ❑ �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 ❑DOMESTIC/FIRE COMBO: 9", 2", OTHER: SINGLE OWNERSHIP.FILL DUT REVERSE S/DE OF THIS FORM. _ , . ` CONTACT INFORMATION : . OWNER NAME: TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET CITY STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME.: � G 'Z° L� � CONTRACTOR ADDRESS: s-rReer �t' !� SG Lyt �� � Cf1Y C �Z°S STATE ZIP $ Z 2 j CONTRACTOR PNONE: lj_ — � CONTRACTOR EMAIL: CONTRACTOR LIC,#�(REQUIRED): CITY OF EVERETT BUSlNESS LIC.#(REQUIRED): D1� PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: CONTACT EMAIL: AGREEMENT.•The u dersigned applicanf agrees to comply with all provisions of the Everett Municipa!Code Tifle City of Evereft Official Use On1y 94 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 ��D�O� the right af any time,without nofice,to shut off or turn on the water supply for repairs,construction,and nonpaymenf of charges or for any other reasonab/e cause.I am the owner,or 1 am authorized by fhe owner of this properry to perform the work for which application is made,and l comply with the State Confractors Law 98.27 PERM IT# R�and 96.200A A/� � : �� � Owner/Authorized Agenf Signature Date (Revised 90/9?J2015)