2029 COLBY AVE 2018-05-14 - Laserfiche WebLink

� � ' .. 1NA,TER / SEWER lJT°ILI°Tl� APPLI�ATI�N 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'SIT INFyORMATION � � , �� $ . , �� , -' -_�� ,:.: ,_...�_; . f ��._.� : �__��.__ ,��x:�..��.�. ,� ,s�. ��,t��a.� � � PROJECT ADDRESS: IF APPLICABLE: ❑OUTSIDE CITY LIM S ❑ BUlLD1NG AREA SF ❑ LOT# BUILDWG TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑DULEX ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL ❑INDUSTRIAL CHANCE OF USE? ND ❑YES, FROM TO ,_,. _ . _ ,,_ .._ . . ,< ,�. � �. . -- . : UTILITY APPLICATiON INFORMATION °' ' ,_: .. :., . ._ . , ._:. . . _�.. T ...... . _ . __ . . _ � SEWER(check all that apply) WATER(check all that apply) ❑ SIDE SEWER REPAIR ❑ NEW WATER SERVICE INSTALLATION ❑SIDE SEWER ALTERATION ❑ COMPLETE SERVICE I�METER ONLY : ❑ NEW SIDE SEWER INSTALLATION SERVICE/METER USE: �I INSTALL BACKWATER VALVE(oufside the building) ❑SFR ' ❑ SIDE SEWER CAP-OFF ❑ MULTI-FAMILY-#OF UNITS: ❑ SIDE SEWER RECONNECTION 0 COMMERCIAL MULTIPLE DOMESTIC WATER SERVICES REQUEST WATER SERVICE TYPE/SIZE: (ci�cle'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: 1", 2", OTHER: SINGLE OWNERSHIP. F1Lt OUT REVERSE S/DE OF THlS FORM. CONTACT INFORMATION OWNER NAME: TENANT NAME(If Commercial): ` OWNER MAILING ADDRESS: srReeT C�-�y STATE 7JF OWNER PHONE: OWNER EMAIL: CDNTRACTOR NAME: CONTRACTOR ADDRESS: sTREer • . CITY � STATE a • ZIP • CONTRACTOR PHONE: � CO TRACTOR EMAIL: � CONTRACTOR LIC.#(REc�UiRED): CITY OF EVERETT BUSIN LIC.#(REQUIRED): V PRiMARY CONTACT:�pIOWNER ❑CONTRACTOR ❑OTHER(Pfease Specify) CONTACT NAME: � CONTACT PHONE: � � '�'��'b Z � Utir'�� V��t 1 Y�.�f n�- CONTACT EMAIL: C C � + AGREEMENT:The undersigned app/icant agrees to comp/y with a/!provisions of fhe Everett Municipa/ de Tit/e City of Ever O�cial Use On/y 14 lNafer and Sewer or such othe�rules and regulations now existing or which may be established from time to FEE time. The applicant fu�ther agrees, a con i" precedenf to receiving service that the ufilities division shall have the right at any ' e,w' f notic ,to shuf off o turn on the water supply forrepairs,construction,and ��4� � nonpayment ch r s or or an other reasona le cause.I am the owner,or 1 am authorized by the owner of this property to p or he wo hich applicatio is made,and 1 comply with the State Contractors Law 98.27 PERMIT# RCW and 29 200 WAC � I/��.y _ �.r/'\ 1 i�" �Y 1 6 � ..�/ wnerlAuthoriz gent Sig ature Date (Revised 90/9?J2015)