2027 GRAND AVE 2022-04-18 - Laserfiche WebLink

�V�� 1�C� � �5'C�nI�G�3 �J�0�0��1� �pi-f�Q�Q`�0�� � ' � �� CITY OF EVERETT PERMIT SERVICES \,.r. 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 � FAX 425-257-8857 � (E) everetteps@everettwa.gov � www.everettwa.gov/permits f�IP3oOJC�C'1i�0�'� O�f�o0f�3fi4�1i�1`�'�oOln� PROJECT ADDRESS: �� / � � IF�4PPLICABLE: ❑ OUTSID�CITY LIM9�S ❑ BUILDING FlREA SF ❑ LOT# BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑DULEX ❑MULTI-FAMILY�#OF UNITS: ❑COMMERCIAL ❑INDUSTRIAL CI-{AiUGE OF USE? �� ❑YES, FROM TO NJ`�01�0`��La[�'��D�La`li'0�1� DIi�1��1�3G�ili CQ1�0 00�`.� S�WER(check all that apply) �il1.�7'�R(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: �INSTALL BACKWATER VALVE(outside the building) ❑ SFR ❑ SIDE SEWER CAP-OFF ❑ MULTI-FAMILY-#OF UNITS: ❑ SIDE SEWER RECONNECTION ❑ COMMERCIAL MULTIPLE DOI�IESTIC WA7ER 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 51NGLE 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: 9", 2", OTHER: SINGLE OWNERSHIP. FILL OU7 REVERSE SIDE OF THIS FORIVI. ��ffd'T/�C°�' 9�1��9SIiliA��9 OVI/NER NAPViE: TEPVAPdT iVAME(If Commercial): OWIVER IVIAILIRIG ADDRESS: srREET CIIY STATE ZIP OV!/NER PHOIVE: OWfVER EMAIL: _- . ..<..--- _.: .,.... .. _.-,—.... . ........ .. .....�_ _._....__ COfVTRACTOR iVAME: �'�,' � COfVTRACTOR ADDRESS: srREe-r �° �^ y� � CITY , � STATE �� ZIP �� ,� - CO�ITRACTOR PHONE:�j � �`�!Q COfUTRACTOR EiUiA1L: ,Q �p/ � � Q � COPdTRACTOR LIC.#(REQUIRED)v � �g � � � C17"Y OF EVERETT 3USIi�E�LIC.#(REQUIRED� � PRIMARY COYVTACT: ❑OWNER ❑ CONTRACTOR ❑ OTHER(Please Specify) CONTACT NAME: COfVTACT PHONE: �� ' �� �U �� U �� ' � � COiV IACT EfV1AIL: ' � c � `�� t a o� � AGRLEMENT.�The undersigned applicant agrees to comply with all provisions of the Everett Municipal ode Title � Cify of Ever t Official Use Only 94 Water and Sev✓er cr such other rules and�egulafions now exisfinq or which may be established from time to FEE time. The applicant fi�rfher a�rees, S`�a cond�' n precedent to receiving service that the ufilities divrsion shall have "� � the right af any e, w t notic , to shut oif o tum on the water supply for�epairs,constructron, and �/lo � nonpayment qf ch r s or'o�an other reasona le cause.l am the owner,or I am authorized by the nwner of this � _ property to pc� or l�e wo < - �hich applicatio ,is rnade,and I comply v✓ith the Sfafe Contrar.tors Law 18.27 �F_RMIT# RCW and?9�200 WAC ' , , n p I��^ �, I ' y--`�� �\L��, �� - ._ U � �i _ �ner/Airthoriz�" . gent Signature Date (Revised 90/92/2095)