2028 HOYT AVE 2022-04-19 - Laserfiche WebLink

_ �V��.: ��°[�G� � �C�N�� 0��`�1`� �pf�OC�G�`�0�� � , �, ' , � � CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 � FAX 425-257-8857 � (E) everetteps@everettwa.gov � wvvw.everettwa_gov/permits IF��JL��iI' �i0�i'L� 0149�oOl�fi�]iQ`��li� PROJECT.4DDRESS: �� 1 � IF APPLICABLE: ❑ OUTSIDE CITY LINiITS ❑ BUILDING AREA SF ❑ LOT# BUILDING'TYPE: ❑SFR-DCTACHED ❑SFR-ATTACHED ❑DULEX ❑MULTI-FAMILY��OF UNITS: ❑COMMERCIAL ❑INDUSTRIAL CNANGE OF USE? �� ❑YES, FROM __TO �U`�OQ O li�LQ��f�OC�Q�'��6� 01`i��ft��lfli�.1`�OoOG`�' S�Vi/EF:(check all that apply) 1lVAT�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 IVIULTIPLE DOi�IESTIC WA�TER SEF2VICES R�QUEST 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 OWNERSNIP. ❑ �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. F/LL OUT REVERSE SIDE OF THIS FORM. �ONTAC� O��ORMA'�101d OWNER NAIVIE: TEiVAPdT iVAME(If Commercial): OWNER IVIAILING ADDRESS: sTaeET CI7Y STATE ZIP OVIlPdER PHOIVE: OlIVNER EPVIAIL: �__...�...:--- - -.., ... .__._. . ..,..... CONTRAC70R PIAIV�E: �' B� COPVTRRCTOR ADDRESS: sTHEeT F� S b�'� � CITI' V STATE �� o ZIP �� COFVTRACTOR PHOftIE:�j � �� CO TRRCTOR EfViAIL: �� '� P/ � �� J e ��/ CONTRAGTOR LIC.#(REQUIRED)o � � � � � �, CITY OF EVERETT BUSINE�LIG#(REQUIRED� � ___. _ ._:__.._ _ PRIMARY COYVTACT: ❑OWNER ❑ CONTRACTOR ❑ OTHER(Please Specify) CONTACT IVAME: o COM7ACT f'HONE: N��`�S� , ' z�7 �t �� Q ��j� �"�� /�� i�,��/' COfd7AC"f�illlAlL: � ` � � `1�� VIKm � �. �tl� 9 ��Pg AGREEMENT:7he undersigned applicant agrees to comply with all provisions of the Everett Municipal ode Tifle � Cify of Ever t Official Use Only 94 Wafer and Sewer or such other rules�nd regulafions now existing or which may be esta6lished iiam time fo FEE time_ The applicant further agrees, S"a cond�' n precedenf to receiviny service that the utilities divisia�shall have � the righf af any e, w t notic , to shut off o tum on the water supply for reparrs, const�uctinn, and ��D O/ nonpayment f ch rc�s or or an other reasona le cause.I am the owner,or I am aufhorized by fl�e ov✓ner of this � p�operty to p ori he v✓o hich applicatio is made,and l comply wifh the State Contrar,fors Law 18.27 PFRMI RCW and 29 200,�WAC t � � �_ � � � � �. �c' t _ - � � ��n� v�� � �. %� ,4 �ner/Aufhorize . gsnt Signafure Date (Revised 90/12/2095)