4906 SEAHURST AVE 2018-06-08 - Laserfiche WebLink

Jew_ _ . WATEk I SEINE* unurtAPPLICATION ---- CITY OF EVERETT PERMIT SERVICES `�� — 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 1 FAX 425-257-8857 I (E) everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: lAck,v(0 5 ki\a..)r6 > 6\Je-N/-e- I LA e1 ZU 3 IF APPLICABLE: 0 OUTSIDE CITY LIMITS ❑ BUILDING AREA SF 0 LOT# BUILDING TYPE: E4SFR-DETACHED ❑SFR-ATTACHED ❑DULEX ❑MULTI-FAMILY-#OF UNITS: DCOMMERCIAL DINDUSTRIAL CHANGE OF USE? `ANO 0 YES, FROM TO UTILITY APPLICATION INFORMATION SEWER(check all that apply) WATER(check all that apply) `K SIDE SEWER REPAIR 0 NEW WATER SERVICE INSTALLATION ❑SIDE SEWER ALTERATION 0 COMPLETE SERVICE 0 METER ONLY ❑ NEW SIDE SEWER INSTALLATION SERVICE/METER USE: ❑ INSTALL BACKWATER VALVE(outside the building) 0 SFR 0 SIDE SEWER CAP-OFF 0 MULTI-FAMILY-#OF UNITS: ❑SIDE SEWER RECONNECTION 0 COMMERCIAL MULTIPLE DOMESTIC WATER SERVICES REQUEST WATER SERVICE TYPE/SIZE:(circle desired size) ❑ I AM DECLINING MULTIPLE DOMESTIC WATER SERVICES FOR 0 DOMESTIC: 3/4", 1", 2", OTHER: MY MULTI-FAMILY DEVELOPMENT UNDER SINGLE OWNERSHIP. 0 IRRIGATION: 3/4", 1", 2", OTHER: ❑ I AM OPTING TO INSTALL MULTIPLE DOMESTIC WATER 0 FIRE: 1", 2", 4", 6", 8", OTHER: SERVICES FOR MY MULTI-FAMILY DEVELOPMENT UNDER 0 DOMESTIC/FIRE COMBO: 1", 2", OTHER: SINGLE OWNERSHIP.FILL OUT REVERSE SIDE OF THIS FORM. CONTACT INFORMATION. OWNER NAME: i w• Med ll-pt,J TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET Lel,(7 C,7 5 r L 1/4.2,c6 1-- AcrrY 4-V r--/c--- STATE �s ZIP Cl(?l3 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: J c o4L-- l...-)e=6\ `,..)..---ko v-- 0 // CONTRACTOR ADDRESS: STREET 2-1A0 \ 3t3 5-- CITY ,See.--#4.-e___ STATE 1-",-)1� ZIP 91 10(0 CONTRACTOR PHONE: Z e,v q 32--- (,`li`I CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED): SOU�Nk F 0i L Cn CITY OF EVERETT BUSINESS LIC.#(REQUIRED): OSc-c 30 PRIMARY CONTACT: 0 OWNER aCONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 7.06,- 49,e4 - 14,1--KC,M, ILe- " to \ S CONTACT EMAIL: AGREEMENT:The undersigned applicant agrees to comply with all provisions of the Everett Municipal Code Title City of Everett Official Use Only 14 Water and Sewer or such other rules and regulations now existing or which maybe established from time to FE time.The applicant further agrees,as a condition precedent to receiving service that the utilities division shall have the right at any time,without notice,t..(ut off or n on the water supply for rep.' construction,and .--- nonpayment of charges or for any. rr reaso-..e cause.l,117-ow. ,or . ..uthorized by the owner of this property to perform the work for• ch appl' . .n is made - •I co,.l�wit ate Contractors L w 18.2 PERMIT# RCW and 296.200A WAC. 3 16t i. e U ZoS - 03i-{ Ik-___ ____/AL- tialop-YA I.I-I-Ill It-A --' — Owner 'uthorized Agent Signature Date (Revised 1011212015)