2514 WETMORE AVE 2018-05-15 - Laserfiche WebLink

� �C� � �CI�C�G� ��I �f�� pLO�G�`1�� �� CITY OF EVERETT PERfV11T SERVICES _ 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 � FAX 425-257-F3857 � (E) everetteps@everettwa.gov � www.everettwa.gov/permits �IRoO�DC��' ��'il� DI��I�V"�liG��i'��'Ir� PROJECT'ADDRESS: ��1 �/ �� 1F APPLICABLE: ❑ OUTSIDE CITY LINiITS ❑ BUILDING AREA SF ❑ LOT# BUILDIYVG l"YPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑DULEX ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL ❑INDUSTRIAL CNANGE OF USE? NO ❑YES, FROM TO NJ`�POl�O`�'�!Q�'�L�O��'IY��L� OIR��fiN'ii/�,1�0 oOG� SE�!/ER(check all that apply) WAT�FZ(check ail that apply) ❑ SIDE SEWER REPAIR ❑ NEW WATER SERVICE IPJSTALLATION ❑ SIDE SEWER ALTERATION ❑ COMPLETE SERVICE ❑ METER ONLY ❑ NEW SIDE SEWER INSTALLATION SERVICE/METER USE: �INSTALL BACKWATER VALVE(outside the building) ❑SFR ❑ SIDE SEWER CAP-OFF ❑ MULTI-FAMILY-#OF UNITS: ❑ SIDE SEWER RECONNECTION ❑ COMMERCIAL MULTIPLE DOIVfES�IC WA7ER SERVICES REQUES�T 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. ❑ �RRIGATION: 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 DUT REVERSE S1DE OF THIS FORM. t�ONI'AC"� 9�C9�ORIV�A�90R8 OWNER NAME: TEfVAPdT PIAME(If Commercial): OWPVER MAILIPdG ADDRESS: s-rRE�r CI�iY STATE ZIP OWNER PHOME: OWPVER EMAIL: COIVTRAC70R iV,4ME: COY�ITRACTOR ADDRESS: sTReer II b° @ 6�� � �CITY STATE � � ZIP � CONTRACTOR PHONE: '� CO TRACTOR E�iiAtL: ,� ��/ � p 6 � CONTRACTOR LIC.#(REQUIRED)o � � � � � C17Y OF EVERETT BU51R7 LIG#(REQUIRED� � _... __...._... PRIMARY CONTACT: ❑OWNER ❑ CONTRACTOR ❑ �THER(Please Specify) CONTACT IVAi111E: COI�TACT PHONE: �� , ' z� ��• �� �� '—� �� CO`dTACT�f111AIL: � � � � �- �� l��a � � J AGI�EEMENT:The undersrgned applicant agrees to comply with all provisions of the Everett Municipal ode Title � Cify of Eve� t Otficial Use Only 94 Water and Sewer or such other rules and regulations now existing or which may be established f�om time to rE� time_ The applicant fi�rther agrees, S�a cond�t precedent fo ieceiving service that the utilities divfsion shall have U� the right at any e, w' f notic , fo shut oir o}�tum on the water supply for repairs,r.onstrzrctron,and nonpayment qf r,h r s or or an ofher reasonaple cause.l am the owner, or I am authorized by fhe ov✓ner of this � �� f property fo p �for he wo dhich applicatior�is made,and I comply v✓ith the State Contractors Law 18.27 PERMIT# RCW and 296�200 WAC t ` � '� ` ! /� � � � O� ^ �� t wner/Authoriz genf Signafure Date (Revised 10/12/2095)