1731 WALNUT ST 2018-05-15 - Laserfiche WebLink

VV� 'ER. / ��V�� `��LI�Y � �LI�A`�IOfV 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"rE INFORM�ITION PROJECT ADDRESS: � �, ��I�/ IF APPI.ICABLE: ❑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 APPLICATIOW 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 ❑ FIRE: 1", 2", 4", 6", 8", OTHER: SERVICES FOR MY MULTI-FAMILY DEVELOPMENT UNDER ❑ DOMESTIC/FIRE COMBO: 1", 2", OTHER: SINGLE OWNERSHIP_ FILL OUT REVERSE SIDE OF TNIS FORM. CONTACT INFORMATION OWNER NAME: TENANT NAME(If Commerciaf): OWNER MAILING ADDR SS: STREET C�7y STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: CONTRACTOR ADDRESS: sTReET V ��ry STATE a • ZIP CONTRACTOR PHONE: '� CO TRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 4 _._. _. ..,.... - . .__ . _ PRIMARY CONTACT: ❑OWNER ❑ CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: e CONTACT PHONE: � � �ib � / i�{�,r��j ��l Y�,"�� CONTACT EMAIL: vvv AGREEMENT:The undersigned applicant agrees to comply with all provisions of the Everett Municipal Code Title City of Evereff Official Use Only 14 Waterand Sewerorsuch other rules and regulations now existing orwhich may be established from time fo FEE � time. The applicanf fu�ther agrees, a con i" n p�ecedent to receiving service that the utilities division shall have the rrghf at any ' e,w t notic ,to shut off o tum on the water supply for repairs,construcfion, and ��. � nonpayment f ch r s or or an other reasona le cause.I am fhe owner,or I am authorized by the owner of this �� property to p or he wo hich applicatio is made,and I comply with the State Contracfors Law 9f3.27 PERMIT# RCW and?_9 200 WAC ��. � � � � / � � —D�� l� wner/Authoriz gent Sig ature Date (Revised 10/12l?_015)