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WATER / SEWER UTILITY APPLICATI�N <br /> C1TY OF EVERETT PERMIT SERV[CES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P}A25-257-881 Q � FAX 425-257-8857 � (E)everetteps@everettwa.gov j �ttww.everetfwa.gav/permits <br /> ` ` � '�r-} PROJECT S1T,E INEQRMATIOM '�� � <br /> PRo,rECT aa�REss �Maple Street <br /> IF APPLICABLE: O OUTSIDE CITY LIMITS ❑ BUILDWG AREA SF ❑ LOT# <br /> BUILDING TYPE: �1SFR-DETACHED ❑SFR-ATTACHED ❑DULEX ❑MULT!-FAMILY-#tpF UNITS: ❑COMMERCIAL ❑INDUSTRIAL <br /> CHANGE OF USE? �N� ❑YES, FROM TO <br /> UTILITY APPL.ICATlQN INFORMATION <br /> SEWER(check all that apply) WATER(check alf that appiy} <br /> 0 StDE SEWER REPAIR ❑NEW WATER SERVICE INSTAILATiON <br /> ❑SiDE SEWER ALTERRTION ❑CQMPLETE SERVICE ❑METER ONIY <br /> ❑NEW SIDE SEWER INSTALLATION SERVICE/METER USE: <br /> ❑INSTALL BACKWATER VALVE(outside the building) ❑SFR <br /> ❑SIDE SEWER CAP-OFF ❑MULTI-FAMILY-#OF UNITB: <br /> �'SIDE SEWER RECONNECTION ❑CQMMERGIAL <br /> MU�.TIPLE DOMESTIC WATER SERVICES REQUEST WATER SERVEGE TYPE/SI2E: (circle desired size) <br /> ❑i AM DEGLINING MULTIPLE DOMESTIC WATER SERVICES FOR � DOMESTIG: 3/4", 1", 2", OTHER: <br /> MY MULTI-FAMILY DEVELOPMENT UNDER 51NGLE OWNERSHIP. ❑ �RRIGATION: 3/4", 1", 2", OTHER: <br /> ❑1 AM OPTING TO INSTALL MULTIPLE DOMESTIC WATER ❑ FIFtE: 1", 2", 4", 6", 8", OTHER� <br /> SERVICES FOR MY MULTI-FAMILY DEVELOPMENT UNDER ❑ DOMESTIClFIRE CQMBO: 1", 2", OTHER: <br /> SfNGLE�WNERSHIP.FItL OUT REVERSE SIDE QF THIS FORM. <br /> CONTACT INFORMATION ' <br /> OWNER NAME: Al1t011 T�iQCY1E?SOCI TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTReeT 2��4 Ma{��e StrL'et <br /> �,�Everett STAtE vv� 21P 98201 <br /> owNE�aHONE: 206-817-3314 owN�a�Ma,i�: antonthampson�hotmaii.com <br /> CONTRAGTOR NAME: SPOSafI It1C., dba Mr. Raoter Plumbing & Heating <br /> GONTRACTOR ADQRE5S: STREET 2000 South 116th Street <br /> �,�Seattle STATE WA zia 6$ ,,. <br /> GONTRACTOR PHONE:2Q6-�5�-2��7 CONTRACTOR EAAAIL: charfenel@mrrooter�ea.com - <br /> CQNTRACTOR UC.#(REQUIRED):MRROOP*022NE C1TY OF EVERETT BUSiNESS LIC.#(REc2u�REo):Q38D80 ', <br /> PRIMARY CONTACT: ❑OWNER �d CONTRACTOR ❑OTHER(Please Specify) %' <br /> CONTACT NAME: CONTACT PHONE:2(}�`j_��j�_2c��7 <br /> � <br /> Chariene Lundgren cor,racreMA��: charlenel@mrrootersea.cor'��--m�-���� <br /> AGREEMENT:The undersigned applicant agrees to comply wtth all provlsions of the Everett Municipal Code T'die 74 Water and Sewer or such ofher rules and regulations now <br /> existrng ot which may tre estabtlshed from time to ttme. The applicanf further agrees,as a eondirion precedent to recerving serv+ce thaf fhe utilities division shall have the r(ghi at any <br /> time,without notice,to shut oK or turn on the weter supply for repairs,constructfon,and nonpayment of charges or lor any other reasonable cause.�am the owner,or 1 am <br /> authonzed by the ovmer of this property to perfonn the work for whlch appNcatlon fs made,and 1 comply wfth the State Contracfors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Officral Use Only <br /> PERMIT# <br /> U � � ' LJ� <br /> ner/Authorized ent Sig re Data (Revised 9/23/20t6J <br />