2110 CEDAR ST 2018-05-14 - Laserfiche WebLink

< �� . � w,�R , s�w�R u-ri�ir� �i��r�oN CITY OF EVERETTPERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 (P)425-257-8810 � FAX 425-257-8857 � (E) everetteps@everettwa.gov( www.everettwa.gov/permits {, � PROJECT SIT� INFORMATION �. ...,.. ., _ .�.�:.b .�.�.,...<�� .�..�. �� .�.. �.�� .��,,..� ..,_,��.. �.�.�� .._.�,�;.�,�:,� ��, xv�_ ,� � PROJECT ADDRESS: � IF APPLICABLE: ❑OUTSIDE CITY LIMITS ❑ BUILDING AREA SF ❑ LOT# BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑QULEX ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL ❑INDUSTRIAL CHANGE OF USE? NO ❑YES, FROM TO _�_ ;.,. � UTILITY APPLICATION I.NFORMATION ". SEWER(check all that apply) WA7ER(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: �I WSTALL 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/StZE: (circle desired size) ❑ I AM DECLINING MULTIPLE DOMESTIC 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.F/LL OUT REVERSE S/DE OF TH/S FORM. : < ` CONTACT INFORMATION OWNER. , ..__ ._ .. . _ .. NAME: � TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET q'�y STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: CONTRACTOR ADDRESS: s-rReer • CIIY STATE a • ZIP CONTRACTOR PHONE: � CO TRACTOR EMAIL: CONTRACTOR LIC.#(REclU1RED): CITY OF EVERETT BUSINESS L[C.#(REQUIRED): 4 PRIMARY CONTACT: ❑OWNER� ❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: � CONTACT PHONE: � C.t 5•�'b Z �r��j �,�`� Ya,"�� CONTACT EMAIL: AGREEMENT.�The undersigned applicant agrees to comply with all provisions of the Everett Municipa!Code Title City of Everett Official Use Only 14 lNater and Sewer or such other rules and regulations now existing or which may be established from time to FEE time.The applicant furfher agrees, a con i' precedenf to receiving service that the utilifies division shall have the right at any ' e,w' t notic ,to shut off o turn on the water supply for repairs,construction,and ��Q �O nonpayment ch r s or or an otherreasona le cause.1 am the owner,orl am authorized by the owner of this property to p or he wo hich applicatio is made,and I comply with the State Contractors Law 98.27 PERMIT# RCW and 29 200 WAC ll � � �� I- D 2 wnerlAuthoriz gent Sig ature Date (Revised 90/92/2015)