2024 GRAND AVE 2018-05-15 - Laserfiche WebLink

�i `�CG�3 � �C��nIC�G�3 M`�0��`�� G°��OC� �,�'DOo �� � CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 � FAX 425-257-8857 � (E) everefteps@everettwa.gov � www.everettwa.gov/permits �I�o0�11C��i( �D�i'I� OQ��oOf�G�`1iL�1`�'0�[i� PROJECT�4DDRESS: � �� IF�4PPLICABLE: ❑ OUTSIDE CITY LIMI ❑ BUILDING AREA SF ❑ LOT# BUILDIiVG TYF'E: ❑SFR-DETACHED ❑SFR-ATTACHED ❑DULEX ❑MULTI-FAMILY�#OF UNITS: ❑COMMERCIAL ❑INDUSTRIAL CHAIVGE OF USE? �� ❑YES, FROM TO 11J1irOL0`l�'�Q��f�O��'��I� 0,�'�I�o01�3�117�.1�Da0il`� SEI�/EF2(check all that apply) WAT�FZ(check all that apply) ❑ SIDE SEWER REPAIR ❑ IVEW WATER SERVICE INSTALLATION ❑ SIDE SEWER ALTERATION ❑ COMPLETE SERVICE ❑ METER ONLY ❑ NEW SIDE SEWER INSTALLATION SERVICE/METER USE: �INSTALL BACKWATER VALVE(outside the building) ❑ SFR ❑ SIDE SEWER CAP-OFF ❑ MULTI-FAMILY-#OF UNITS: ❑ SIDE SEWER RECONNECTION ❑ COMMERCIAL MULTIPLE DOMESTIC VVA7ER SERVICES REQUESl' WATER SERVICE IYPE/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. ❑ 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/FfRE COMBO: 1", 2", OTHER: SINGLE OWNERSHIP. F/LL OUT REVERSE SIDE OF THIS FORM. �ON�AC� 09��0�$MA�T80N OWNER NAIVIE: TENAPd7'FIAiViE(If Commercial): OVI/f�IER MAILIPVG ADDRESS: srRee-r CfTY STATF ZIP OVVNER PHOIVE: OlNNER EMAIL: COfVTRA ,.., --_. _ ..,_. . . ,_ C70R PdAfl�E: �^, � COPdTRACTOR�4DDRESS: sTReer � �° d �r��r � CITY � STATE �� ZIP �, CONTRACTOR PHONE: �, '�!� CO TR�.C?OR EMAIL: I Q �p � �� e ��Y! COFVTR�4CTOR LIC.#(REC�UIRED): � � � � � �, �, CITY OF EVERETT BUSIYV LIC.#(REQUIRED� � _. __.,._.._ _ PRIMARY COi�TACT: ❑OWNER ❑ CONTRACTOR ❑ OTHER(Please Specify) CONTACT IVAME: CORITACT PHORIE: �� , �� `�� �N�41�✓��`/� �I�� '� % CONTAC-f EiViAIL' � o � I� �� 3`�a 0 �. �N l AGREEMENT.�The undersrgned appGcant agrees to comply with al!provisions of the Everett Municipal ode Title � Cify of Ever f Official Use Only 9�Water and Sewer or such other rules and regulafions now existing or which may be established from time to FEE time_ The applicant fu�her agrees,�aS"a condi� �precedent fo receiving service that the ufilifies division shall have y�, �`\ �� fhe right af any ' e,w' t notice�, to shut off o tum on fhe water supply for repairs,constrzrction, and l� V� nonpayment�f ch r s o� o�an�other reasona le cause.I am ihe otvner, or I am authorized by the owner of thrs — properfy to p for he wo hich applicatior�is made,and 1 comply wifi�the Sfate Conti�cto�s Law 18.7_7 PERMIT# RCW and?_9 200 WAC � ,�l � � �G� �° .. _ � � �� v�� wner/Aufhoriz gent Signafure Date (Revised 10/12/2015)