1903 OAKES AVE 2018-05-15 - Laserfiche WebLink

I � .. � _ __'�� I ��!� ��'�'�� __ '��'��I�� 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 SIT'E INFARNiAT10W PROJECT ADDRESS: ` � O� IF APPLICABLE: ❑ OUTSIDE CITY 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: �I INSTALL BACKWATER 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: (circie 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/FIRE COMBO: 1", 2", OTHER: SINGLE OWNERSHIP_ F/LL OUT REVERSE SIDE OF THIS FORM. CONTACT INFORMATION OWNER NAME: ��V TENANT NAME(If Commercial): OWNER MAILING ADDRESS: sTReer C�7y STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: CONTRACTOR ADDRESS: sTtzeeT V CITY STATE a e ZIP CONTRACTOR PHONE: '� CO TRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 4 PRIMARY CONTACT: ❑OWNER ❑ CONTRACTOR ❑ OTHER(Piease Specify) CONTACT NAME: � CONTACT PHONE: � � 5�b Z �r��j �V�� ,''�/l� CONTACT EMAIL: AGREEMENT:The undersigned applicant ag�ees to comply with alI provisions of the Evere(t Municipal Code Tifle City of Everett Official Use Only 14 Wafer and Sewer or such other rules and regulations now existing or which may be established from time fo FEE time. The applrcant fu�ther agrees, a con �� n p�ecedent to receiving service that the utilities division shall have Q fhe right at any ' e,w' t notic ,to shut off o turn on the water supply for repairs,construction, and � 3 D` � no�paymenf f ch r s or or an other reasona le cause.I am the owner, or I am authorized by the owner of this property fo p or he wo hich applicatio is made,and 1 comply with the State Confractors Law 18.27 PERMIT# RCW and 29 200 WAC /" � � � � I f � I /�� � ��.�_.-6� \X' wner/Authoriz gent Sig ature Date (Revised 90/12/2015)