2120 CEDAR ST 2018-05-14 - Laserfiche WebLink

, t �. � W�-R / SEWER UTILIT'l� A.■�LICATION ' 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 , , PROJECT SITE INFORMATION.:. � � . ...�,U ._,,�. �.. s. _.f_ ._ ... _� ._ ._ ,_ _ ._. .. _ . ... . PROJECT ADDRESS: �f . IF APPLICABLE: ❑OUTSIDE CITY LIMITS ❑ BUILDING AREA SF ❑ LOT# BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑DULEX C�MULTI-FAMILY�OF UNITS: ❑COMMERCIAL ❑INDUSTRIAL CHANGE OP USE? N� ❑YES, FROM TO UTILITY APPLICATION INFORMATION � � SEWER check all�t� �.. __ . _e , , _ __ � ( hat 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 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/SIZE:(circle desired size) ❑ i AM DECLINING MULTIPLE DOMESTIC WATER SERVICES FOR ❑ DOMESTIC: 3/4", 1", 2", OTHER: MY MULTI-FAMILY DEVELOPMENT UNDER SINGLE OWNERSH(P. ❑IRRIGATION: 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: 1", 2", OTHER: SINGLE OWNERSHIP. FILL OUT REVERSE S/DE OF THIS FORM. � . �, a.. . . . . , CONTACT INFORMATI.ON ' OWNER NAME: � � TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET ��7y STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: CONTRACTOR ADDRESS: s-rReer • CIIY STATE a, • ZIP CONTRACTOR PHONE: � CO TRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS L(C.#(REQUIRED): D PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ❑OTHER(Piease Specify) CONTACT NAME: � CONTACT PHONE: � (,t �•�'b Z, � �,r�s VV��I Y�,�fn�- CONTACT EMAIL: AGREEMENT.�The undersigned applicant agrees to comply with al!provisions of the Everett Municipat Code Title City of Everett Official Use Only 14 Water and Sewer or such other rules and regulations now existing or which may be established f�om time to FEE � time.The applicant further agrees, a con i precedent to receiving service that the utilities division shal!have �[� � the right at an ' e,w' t notic ,to shut off o turn on the water supply for repairs,construction,and � 0l1 ). � non,oayment f c r s or r an other reasona le cause.I am the owner,or 1 am authorized by the owner of this cJv property fo p or he wo hich applicatio is made,and I comply with the Sfate Contractors Law 98.27 PERM IT# RCW and 29 200 WAC � �� ( _ � I t � 1 f �� Wi t wner/Authoriz gent Sig ature Dat (Revised 90/92/2095)