2123 HOYT AVE 2018-05-15 - Laserfiche WebLink

• � VVA��R / 5�� TILI`�� AP��I��'I�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 PROJEC7' SI`�'E IIdFOFZN9AT101�1 PROJECT ADDRESS: � IF APPLICABLE: ❑OUTSIDE CI LIMITS ❑ BUILDING AREA SF ❑ LOT# BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑DULEX ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL ❑INDUSTRIAL CHANGE OF USE? NO ❑YES, FROM TO UTILITY APPLICATION INFORMATION SEWER(check all that apply) WATER(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 BACKVIIATER 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 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 IJNDER ❑ DOMESTIC/FIRE COMBO: 1", 2", OTHER: SINGLE OWNERSHIP. FILL OUT REVERSE SIDE OF THIS FORM. ' CONTACT INFORMATION OWNER NAME: TENANT NAME(If Commercial): OWNER MAILING ADDRESS: sTReer C17Y STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: CONTRACTOR ADDRESS: sTREEr � ��7y STATE � • ZIP CONTRACTOR PHONE: '� CO TRACTOR EMAIL: • I CONTRACTOR LIC.#(REQUIRED): ( O CITY OF EVERETT BU51N LIC.#REQUIRED): PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ❑ OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: � L•� ��'b Z U�,r�� Y�,��' CONTACT EMAIL: � ` � � � � AGR[EMENT:The undersigned applicant agrees to comp/y with a//provisions of the Everett Municipal ode Tit/e Cify of Ever t Otficial Use Only 94 Water and Sewer or such ofher�ules and regulations now existing or which may be established from fime fo FEE time. The applicant further agrees, a con� n precedent to receiving service that the ufilities division shall have 1� �O O� the righf af any ' e,w' t notic , to shut off o tum on the water supply for repairs,construction, and �,� / nonpayment f ch r s o� or an other reasona le cause.l am fhe owner,or!am authorized by the owner of fhis property to p or he wo hich applicatio is made,and I comply with the Sfate Confractors Law 98.27 PERMIT# RCW and 29 200 WAC ��e�....,.-�� l� �D�-6 Z wnerlAuthoriz gent Sig ature Date (Revised 10/97J2095)