515 E BEECH ST 2018-05-14 - Laserfiche WebLink

� . vv�� < s�v�� i�i��r ��i��io� ' CITY OF EVERETT PERM(T SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 � FAX 425-257-8857 � (E) everetteps@everettwa.gov � www.everettwa.gov/permits PROJECT S1TE INFOR,M/ATIAN; PROJECT ADDRESS: e IF APPLIGABLE: ❑OUTSIDE CITY LIMITS ❑ BUILDiNG AREA SF ❑ LOT# BUILDINGTYPE: ❑SFR-DETACHED ❑SFR-ATTACHED��DULEX CIMULTI-FAMILY-#OFUNITS:_ ❑COMMERCIAL ❑WDUSTRIAL CHANGE OF USE? ND ❑YES, FROM TO _ ?.: ; ' UTILITY APPLICATION INFORMATION . __.� � SEWER(check all that'apply) WATER(check ali that apply) �SIDE SEWER REPAIR ❑ NEW WATER SERVICE fNSTALLATION ❑ SIDE SEWER ALTERATiON ❑COMPLETE SERVICE ❑,METER ONLY ❑ NEW SIDE SEWER WSTALLATION SERVICE 1 METER USE: � INSTALL BACKWATER VALVE(outside the building) ❑SFR ❑SIDE SEWER CAP-OFF ❑MULTI-FAMILY-#OF UNITS: ❑SIDE SEWER RECOfYNECTION ❑COMMERCIAL MULTIPLE DOMESTfC WATER SERVICES REQUEST WATER SERVICE TYPE/SIZE: (circle desired size) ❑ i AM DECLINING MULTIPLE bOMESTIC WATER SERVICES FOR ❑ DOMESTIC: 3/4", 1", 2", OTHER: MY MULTI-FAMILY DEVELOPMENT UNDER SINGLE OWNERSHIP. � IRRIGATION: 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: 1", 2", OTHER: SINGLE OWNERSHIP. FILL OUT REVERSE S1DE OF THIS FORM, CONTACT INFORMATION OWNER NAME: TENANT NAME(If Commerciai): OWNER MAILING ADDRESS: srReer CITY STATE ZIP OWNER PHOPIE: OWNER EMAIL: CONTRACTOR NAME: CONTRACTOR ADDRESS: sTReer Y • ��-�y STATE � • ZIP _- • CONTRACTOR PHOfVE: CO TRACTOR EMAIL: i CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSIN LIC.#(REG2UIRED): � __._.,�. .,.,��.Y..<<._�,.,..,�_�.�.��_.�.. «:,�„r � �., . PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ❑OTHER(Please Specify} CONTACT NAME: � CONTACT PHONE: � , �'�'' ,2� /1��,�'�LJ �,�`l Y�•'�� CONTACT EMAIL: � C � a ` ��rV AGREEMENT.�The undersigned applicant agrees to comply with all provisions of the Everett Municipal de Title Cify of Ever Official Use Only 94 VUater and Sewer or such other rules and regulations now existing or which may be established from time to FEE time. The applicant further agrees, a con i' precedent to receiving service that the utilifies division shall have ' the right af any ' e,w' t notic ,to shut off o turn on the water supply for repairs,construction,and �� nonpayment ch r s or or an other reasona le cause.I am the owner,or I am authorized by the owner of fhis properfy to p or he wo hich appiicatio is made,and I comply with the State Contractors Law 98.27 PERMIT# RCW and 29 200 WAC � j/� O�� /� � L V wner/Aufhoriz gent Sig ature Date (Revised 90/92/2095) -