1917 OAKES AVE 2018-05-15 - Laserfiche WebLink

. � ' 11V� � � �R / �EI/�V�� 'II�I�Y �rtI P�IC/��ION 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 PROJECT SITE INFORNiAT10N PROJECT ADDRESS: ` � � 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. ❑ ►RRIGATION: 3/4", 1", 2", OTHER: ❑ I AM OPTING TO INSTALL MULTIPLE DOMESTIC WATER ❑ F1RE: 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: TENANT NAME(If Commercial): OWNER MAILING ADDRE S: sTREer CITY STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: CONTRACTOR ADDRESS: srREeT y • CITY STATE a • ZIP CONTRACTOR PHONE: '� CO TRACTOR EMAIL: CONTRACTOR LIC.#(RECIUIRED): C1TY OF EVERETT BUSINESS LIC.#(REQUIRED): O PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ❑ OTHER(Please Specify) CONTACT NAME: � CONTACT PHONE: � � ��b Z /1��,`/�� ,��l ��,'�� CONTACT EMAIL: vvv AGREEMENT:The undersrgned applicant agrees to comply with all provisions of the Everett Municipal Code Tifle City of Everett Official Use Only 14 Water and Sewer o�such other rules and regulations now existing or which may be established from time to fime.The applicant further agrees, a con �' n p�ecedent to receiving service that the utilities division shall have FEE � �� O� fhe right at any ' e,w t notic ,to shut off o tum on the water supply for repairs,consfruction, and � nonpayment f ch r s or or an other reasona le cause.l am the owner, or I am aufhorized by the owner of this p�operty to p or he wo hich applicafio is made,and 1 comply with the State Contractors Law 9827 PERMIT# RCW and 29 200 WAC /. � � � � i �D^ � �_...�-- ,1 � �O I � wner/Authoriz gent Sig ature Date (Revised 10/12/2015)