2606 MAPLE ST 2018-05-15 - Laserfiche WebLink

; �� G� ��0�� p�0�Q�0�� �.. ' � �� 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 �1�3��1C��11' ��'�L� 01�lI�oO�G�liL�l`�0�6� PROJECT ADDRESS: �^ O�,(1 �� IF APPLfCABLE: ❑ OUTSIDE CITY LIMITS BUILDING AREA SF ❑ LOT# BUILDING 7YPE: ❑SFR-UETACHED ❑SFR-ATTACHED ❑DULEX ❑MULTI-FAMILY-�#OF UNITS: ❑COMMFRCIAL ❑INDUSTRIAL CHAPVGE OF USE? NO ❑YES, FROM TO NJ`�OL�O1`�'1`�Q�'�f�9��DoO� D��G1��`�P0�1� SLV!/EI�(check all that apply) 1i1lATER(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 ihe building) ❑ SFR ❑ SIDE SEWER CAP-OFF ❑ MULTI-FAMILY-#OF UNITS: ❑ 51DE SEWER RECONNECTION ❑ COMMERCIAL MULTIPLE DOI�IESTIC WATER SERVICES REQUESl' WATER SERVICE TYPE/SIZE: (circle desired size) ❑ I AM DECLINING MULTIPLE DOMESTIG 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 MULT]-FAMILY DEVELOPMENT Uf�DER ❑ DOMESTIC/FIRE COMBO: 1", 2", OTHER: SINGLE OWNERSHIP. FILL OUT REVERSE SIDE OF THIS FORM, t�;�sd�'/�� 9Ba9F0031111/�`�'90N OWNER tJAPV1E: TENAPdT P1AME(If Commercial): OWNER MAILIIVG ADDRESS: sTRE�r ��-�y STATE ZIP OWNER PHOIVE: 011YNER EfVIAIL: COfVTR+4C70R PIP.ME: I COfVTRACTOR ADDF2ESS: sTREEr @� �^ �� � ��Ty �� STATE � o ZIP � COBVTRACTOR PHORIE:�j �'� ,� CO T[�ACTOR EMAIL: �p �Q/ �� 0 9 CONTRAC70R LIC.#(REQUIRED): � �g � � � � C17'Y OF EVERETT BUSIIVE�LIC.#(REQUIRED): � PRIMARY CO�ITACT: ❑OWNER ❑CONTRACTOR ❑ OTHER(Please Specify) CONTACT fVAME: CONTACT PHOIVE: �� �f� �` Z� �v� �� ,�� / CONTACT EfllIAIL: � � � �� o � AGfZEEMENT:The undersigned applicanf agrees to comply with all provisions of the E_vereft Municipa/ ode Title � Cify of F_ver t Official Use Only 14 Waterand Sewer orsuch other rules and regulations now existing or which may be established fiom time to FEE time. The applicant fi�rther agrees, S�a condi n precedent to receiving service that!he utilities division shall have O� the righf at any e, w' t nofic , to shut ofi o tum on the wafer supply for repai�s,construcfion, and � 3�„ � nonpayment f ch r s or or an other reasona le cause.I am the om�ner,or I am authorized by the owner of this _ property to p ior he wo ��hich applicatior�is made,and I comply ia�ith the State Coniractor.s Law 18.27 pERMIT# RCW and 29 200�WAC ' � � � % �J )� � ��(� wner/Authoriz gent Signature �ate (Revised 90/92/2015)