2327 LEXINGTON AVE 2018-05-22 - Laserfiche WebLink

,I • ' / �4 �1�� / ��YJ L1�� V�� 1� �� `��Y��9 CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 � FAX 425-257-8857 � (E) everetteps@evereftwa.gov � www.everettwa.gov/permits . PROJEC7 SI7"E INFOIZMA'TIOM PROJECT ADDRE55: ��d / �'` ��L 1.!/'L �,J/l >� 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) I�SIDE SEWER REPAIR ❑ NEW WATER SERVICE 1NSTALLATION ❑ SIDE SEWER ALTERATION ❑ COMPLETE SERVICE ❑METER ONLY ❑ NEW SIDE SEWER fNSTALLATION SERVICE/METER USE: ❑ 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/51ZE: (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", OTNER: SINGLE OWNERSHIP. F/LL OUT REVERSE SIDE OF THIS FORM. , CONTACT INFORMATION OWNER NAME: �'��%�JS �j��;�j�' TENANT NAME(If Commercial): OWNER MAILING ADDRESS: sTReeT j�—i �; �,y=�i��0✓1 �- � CITY '��/`—C l � STATE� ZIP� � OWNER PHONE�`�� ,�?��-7'J 7� OWNER EMAIL: ,..�:: ..�»�.....w. ,<_...,.__,.w,,:....,��. _.............�,_... .y..... ._.. .,, CONTRACTOR NAME: �(,t� (��`7�'��% ' ��IGC.�C.J�°`�l'�l{l� -- -/_.f'�� S r,`J� "' , � � � � , CONTRACTOR ADDRESS: sTReer !.��ro� � �' .� CITY ,��J✓"V�.�� STATE � ZIP / � ��C7�a CONTRACTOR PHONE: 4� � �� % CONTRACTOR EMAIL: CONTRACTOR LIC.#(RECIUIRE�):/j�i.�I��✓E,� �c� �% CITY OF EVERETT BUSINESS LIC.#(REQUIRED): PRIMARY`CONTACT: ❑OWNER ^ C�CONTRACTOR ❑ OTHER(Please Specify) CONTACT NAME: CONTACT PHONE �r,�� _.�j�j v!'�J?� �J�-�/� /-. CONTACT EMAIL:��_�� %i Y�/� . C�Y� � �1/ � r . AGREEMENT.'The undersigned applicant agrees fo comply with a0 provisions of the Everett Municipal Code Title City of Everetf Offcial Use Only 94 Waterand Sewerorsuch other rules and regu/afions now existing orwhich may 6e established from time to FEE time. The applicant further agrees, as a condition precedent to receiving service thaf the ufilities division shall have t � the�ight at any time,without notice,to shuf off or tum on the water supply for repairs,construction,and ��'v ' ✓� nonpayment of cl�arges or fo�any other reasonab/e cause.I am the owner,or l am authorized by fhe owner of this property to perform the work for which app/icafion is made,and I comply with fhe Sfafe Contractors Law 18.27 PERMIT# RCW and 296 AC. • � � i� �i� � � � ;�-� ; -� / " 1 ��J � / ' J � i ,�. . OwnerlAufhorized Agent Signature Date ((Zevised 90/92/2095)