1010 E MARINE VIEW DR 2018-05-22

�' a:`�[�� S��r1�G3 ��'OLD`�� G��O��d�� Cll-Y OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-2�7-8810 � FAX 425-257-8857 � (E) everetteps@everetiwa.gov � www.everettwa.gov/permits �r�� a��a�� PROJECTADDRESS: (� /F= �,l�N�6(�' (,/;fL:✓ �, ; IF APPLICABLE: ❑ OUTSIDE CITY LfMITS ❑ BUILDING AREA SF ❑ LOT# BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑DULEX ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL ❑INDUSTRIAL CHAFIGE OF USE? � N� ❑YES, FROM TO ��a��o�� o�� SEWEi�(check all that apply) WATER{check all that apply) �IDE SEWER REPAIR ❑NEW WATER SERVICE INSTALLATION ❑ 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 DOMESTIC WATER SERVICES REQUEST WATER SERVICE TYPE/SIZE: (circle desired size) � 1 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 INS7'ALL 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 THlS FORM. CONTACT INFORtVlAT1AN OWNER NAME: e�G((,+� � � • �% , �:?�% TENANT NAME(If Commercial): OWNER MAILING ADDRESS; s�eer �� j� � -F�.�j T�Zr CI�TY t.(�'�� STATE�y ZIP G(;� OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: �;r�{— �� CONTRACTORADDRESS: sr�eE-r '�� tic {--t C U�. � / CIIY . C�[l 1'( STATE �,/T ZIP ��L�� CONTRACTOR PHOPIE: `��,—6��l—��3 CONTRACTOR EIInA1L: CF,I��Q�� 6yl�j 1 1� CC+�.ry CONTRACTOR LIC.#�(REQUIRED): .�� CITY OF EVERETT BUSINESS LIC.#(REQUIRED): PRIIVIARY CONTACT: ❑OWNER ❑ CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: COiVTACT PHONE: CONTACT EMAIL: AGREEMENT.�The undersigned applicant agrees to comply with all provisions of the Everett Municipa!Code Title City of Evereft Official Use Only 94 Water and Sewer or such other rules and regulations now existing or which may be established from time to FEE�� . time. The applicant further agrees,as a condition precedent to receiving service that the ufilities division shall have _ the right at any time,without nofice,to shut otf or turn on ihe water supply for repairs,construcfion,and nonpayment of charges or for any other reasonable cause.I am the owner,or I am authorired by the owner of this property to perform ihe work for which application is made,and I comply with the State Contiactors Law 18.27 PERM IT# RCW and 296. A � � ^� O� � — /((J C� � r Owner/Aufhorized Agent Signature Date (Revised 10/12/2015)