2316 MCDOUGALL AVE 2018-05-23 - Laserfiche WebLink

1!�E �� '�� B �[��' �1f ��,0�� G�f�OC�� ll�O� CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 9820� (P)425-257-8810 � FAX 42�-257-8857 � (E) everetteps@everetfwa.gov� www.everettwa.gov/permits P��`� ��°[� Q��'��6i��'9�6�1 PROJECTADDRESS: i- �� :�� ,�� IF APPLICABLE: ❑ OUTSIDE CITY LIMITS � ❑ BUILDING AREA SF ❑ LOT# BUILDIfVG TYPE: ❑SFR-DETACHED j�SFR-AT��ACHED ❑DULEX ❑MULTI-FAMILY-#Of= UNI"TS: ❑COMMERCIAL ❑INDUSTRIAL CH,4PIGE OF USE? /�`�� ❑YES, FROM TO ��s�a�rv��o�w�a�� o��a� SEWER(check all that apply) WATER(check all that apply) ❑SIDE 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) ❑ 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 MUL71-FAMILY DEVELOPMENT UNDER ❑ DOMESTIC/FIRE COMBO: 1", 2", OTHER: SINGLE OWNERSHIP. FILL OUT REVERSE SIDE OF THIS FORM. CONTACT INFORM/�'i'ION OWNER NAME: " ,i1 Q l TENANT NAME(If Commercial): OWNER MAILING AD RESS: srREeT 2 ,? ��( '� CfTY � "�'� STATE yV'' ZIP � OWNER PHONE: �JZ/ �Z�I� — �� 7 7 OWNER EMAIL: �� -� '� , , CC�✓�� _,....... _.. _, _ .. - -- __ . ..__..-. . • - _._ _ ..�_ . _ . ,. _ ._ . _ . . .. . . _.,._ __ _ CONTRACTOR NAME: - -� � CONTRACTOR ADDRESS: sraEer CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EM,41L: CONTRACTOR LIC.�f(REc1UIRED): CITY OF EVERETT BUSWESS L1C.#(REC,2UIRED): PRIIVIARY CONTACT: ❑OWNER ❑CONTRACTOR ❑OTHER(Please Specify) COAITACT NAME: CONT,4CT PHONE: CONTACT EMAIL: AGREEMENT.�The undersigned applicanf agrces to comply with all provisions of the Everett Municipal Code Title City of Evereff Official Use Only 94 Water and Sewer or such otlier rules and re,qulations now exisfing or which may be established from trme to FE E fime. The applicant fu�ther agrees,as a condition precedent fo receiving service that the ufilities division shall have the right at any time,wrfhout notice,to shut off or turn on the water supply for repairs,construcfion,and nonpayment of charges or for any ot6er reason e cause.I am ihe owner,or!am authorized by the owner of this property to pedorm the work for.wliich�appli on is made,and I comply with the State Contracfors Law 1 F3.27 PERM IT�� RCW and 296.200A W!l C.�, � - , --� ------ I -- ' { l � • O ne uthoriz� Agent Sig ture _ - " Ua'te (Revised 90/12/2015) ��' �� �=-