1727 WALNUT ST 2018-05-15 - Laserfiche WebLink

UV/ ER / 5�1�� TILI�Y ��I�A�'ION P 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 INFORM�►TION 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 IYPE/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. ❑ IRRIGATION: 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: � r TENANT NAME(If Commercial): OWNER MAILING ADDRESS: s-rReer ��7y STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: CONTRACTOR ADDRESS: sTREer y C�7y STATE a, • ZIP CONTRACTOR PHONE: � CO TRACTOR EMAIL: CONTRACTOR LIC.#(REc1UIRED): CITY OF EVERETT BUSINESS LtC.#(REQUIRED): 4 PRIMARY CONTACT: ❑OWNER ❑ CONTRACTOR ❑ OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: � I•� 5�'b Z �r��j ��l ��,'�/� CONTACT EMAIL: AGREEMENT:The undersrgned applicant agrees to comply wifh all provisions of the F_vereff Municipal Code Tifle City of Everett Official Use Only 94 Water and Sewer or such ofher rules and regulations now exisfing or which may be established from time to FEE time. The applicanf fu�ther agrees, a con �� precedent to receiving service that the utrlities division shall have the right at any ' e,w' f notic ,to shut off o tum on the water supply for repairs,construction,and Q �/ nonpayment f ch r s or or an other reasona le cause.I am the owner, or I am authorized by the owner of fhis property to p or he wo hfch applicatio is made,and 1 comply with the State Contractors Law 98.27 PERMIT# RCW and 7_9 200f WAC _ t I � j r � O 1 / �_�,��-�/ `� ll6l � �[n wnerlAuthoriz gent Sig ature Date (Revised 10/92/2015)