1826 WALNUT ST 2022-05-17 - Laserfiche WebLink

+ . 11V! � i ER / S�IIV�R �`�Il�l`�Y ��I�A`�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 PROJEC7' S17'E INFORMATION PROJECT ADDRESS: N 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: (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 THIS FORM. CONTACT INFORMATION OWNER NAME: � TENANT NAME(If Commerciaf): OWNER MAILING ADDRESS: sTReeT ��7y STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: CONTRACTOR ADDRESS: sTReEr y ��7y STATE a • ZIP CONTRACTOR PHONE: � CO TRACTOR EMAIL: CONTRACTOR LIC.#(RECIUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): O PRIMARY CONTACT: ❑OWNER ❑ CONTRACTOR ❑ OTHER(Please Specify) CONTACT NAME: � CONTACT PHONE: � � 5�'b °L / ��,`I��j �,�� Y�,'�� CONTACT EMAIL: VYV AGREEMENT:The undersrgned applicanf agrees to comply with al!provisions of the Evereff Municipal Code Title Cify of Evereft Official Use Only 14 Waterand Sewerorsuch other rules and regulations now existing orwhich may be established from time to FEE time. The applicant further agrees, a con �" n precedent to receiving service thaf the utilities division shall have the right af any � e,w' t notic ,to shut off o turn on the water supply for repairs,construction, and ��L� nonpayment f ch r s or or an other reasona le cause.I am the owner,or 1 am authorized by the owner of this `� properfy to p or he wo hich applicatio is made,and 1 comply wifh the Sfate Contractors Law 98.27 PERMIT# RCW and 29 200 WAC �_ I � � � I J !�� �lS� � �LJ wner/Authoriz gent Sig ature Date (Revised 90/12J2095)