2504 WETMORE AVE 2022-05-17 - Laserfiche WebLink

. �� .��0�0��,�0�� CITY OF EVERETT PERMIT SERVICES _ 3200 CEDAR STREET; EVERETT, WA 98201 (P)425-257-8810 � FAX 425-257-8857 � (E) everetteps@everetiwa.gov � wvvw.everettwa.gov/permits � ��J�C'�'�1`P� IN�.��EVl��'��N ` _ . � � . ��... �.. _ .. . _.. _ _. , _ � PROJECT ADDRESS: O IF APPLfCABLE; ❑OUTSIDE CITY LIMfTS ❑ BUILDING AREA SF ❑.LOT# BUILDING TYPE: ❑SFR-DETAGHED ❑SFR-ATTACHED ❑DULEX CIMULTI-FAMILY-#OF UNITS: ❑COMMERCIAL ❑INDUS7RIAL CHANGE OF USE? NO ❑YES, FROM TO �8�94,9`�'1(APPLOCA'i'9�� 1�1�'OR�A`�O��d � SEWER(check all that apply) W,4TER(check ail that apply) ❑SIDE SEWER REPAIR ❑ NEW WATER SERVICE INSTALLATION ❑ SIDE SEWER ALTERATION ❑COMPLETE SERVICE . ❑METER ONLY . ❑ NEW SIDE SEWER WSTALLATION. SERVICE/METER USE: �INSTALL BACKWATERVALVE(outsidethe building) ❑SFR ❑ SIDE SEWER CAP-OFF ❑ MULTI-FAMILY-#OF UNITS: ❑ SIDE SEWER RECONNECTION � ❑COMMERCIAL MULTIPLE QOMEST`IG WATER SERVICES REQllESI' WATER SERVtCE IYPE/SIZE: (circle desired size) ❑ I AM DECLINING MULT(PLE DOMESTIG WATER SERVICES FOR ❑bOMESTIC: 3/4", 1", 2", OTHER: MY MULTI-FAMILY DEVELOPMENT UNDER 51NGLE 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/F(RE COMBO: 1", 2", OTHER: SINGLE OWNERSHIP. FILL OUT REVERSE SIDE OF THIS FORM, . , , ,CONTACT iNFORMATION , OWNER NAME: TENANT NAME(If Commercial): OWNER MAILING ADDRESS: sTReer p�7y STATE ZIP OWNER PHOME: 011VNER EMAIL; CONTRACTOR iVAME: CO►VTRACTOR ADDRESS: srReer �' fr� CITY � STATE �, a � ZIP � CONTRACTOR PHOIVE: CO TRACTOR Et1�A1L: 1 ' e ' CONTRACTOR LIC.#(REQUIRED): � CITY OF EVERETT BUSIIV LIC.�#(REQUIRED): � PRIMARY CONTAG7: `[]OWNER �CONTRACTOR ❑OTNER(Please Specify) CO�ITACT NAiVIE: , CONTACT PHO{VE: I�°� , Z'�'y ,Z� /�1�� `� �� CONTACT EMAIL: c � � e � � AGREEMENT.•The undersigned applicant agrees to comply with all provisions of the Everett Municipal de Tifle '�ity of Ever t Offcial Use Only 94 Vl/ater and Sewer or such other rules and regulations now exisfing or which may be established from time to FEE time. The applicant furfher agrees, a con i precedent to receiving seivice that the utrlities division shall have the rrght at any � e,w' t notic ,to shut off o turn on the water supply for repairs,construction,and �� i nonpayment f ch r s or or an ofher reasona le cause.I am the owner,or I am authorized by the owner of this ` p�operty to p or he wo hioh applicafio is made,and I comply with the State Contractors Law 18.27 PERMIT RCW and 29 200 WAC � 1 D�-.o�5t� wner/Aufhoriz gsnf Sig ature Date (Revised 90/92/2095)