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WATER I SEWER UTILITY APPLICATION <br /> • QF EVERETT PERMIT <br /> , TY <br /> 3200 CEDAR STREET,EVERETT,WA 88201 <br /> (P).425-257-8810 1 FAX 425-257-8857 1 (E)evterettepc@7rs. e rerettwww <br /> a. av 1 v .everettwa.gov/perrrtits <br /> PROJECT ADDRESS: 8903 4th Place SE <br /> IF APPLICABLE: 0 OUTSIDE CITY LIMITS 13 BUILDING AREA SF .0 LOT# <br /> BUILDING'TYPE: ❑sFR-DETACHED 0S4FRATTACHED EIDULEX CDMULTI-FAMILY, 4 OF Uhl.IT ['COMM€RCIAL C11N:IiDi1STRIAL <br /> CHANGE OF USE? D NO 0 YES, FROM TO . <br /> , r yX ,c UTI1t #0RWii ii + x1 Ni-NFW1Ailfj�l O <br /> ., SEWER(check all that apply) WATER(check all that.app y) <br /> 0•SIDE SEWER REPAIR 0 NEW WATER SERVICE INSTALLATION <br /> 0 SIDE SEWER ALTERATION 0 COMPLETE SERVICE 0 METER ONLY • <br /> C)NEW SIDE SEWER INSTALLATION ' SERVICE I METER USE: <br /> Q INSTALL BACKWATER VALVE(outside the building) 0 SFR <br /> 0 SIDE SEWER CAP-OFF 0 MULTIFAMILY-#OF UNITS: <br /> • P SIDE SEWER RECONNECTION D COMMERCIAL <br /> MULTIPLE DOMESTIC WATER SERV1 ES REQUEST ' WATER SERVICE TYPE I$IZ,Et(etre Ie t#esir+ed size) <br /> DI AM DECLIlNiNO MULTIPLE DOMESTIC WATER SERVICES FOR 0 DOMESTIC: 314"", "C '", 2" OTHER: <br /> MY MULTIFAMIL `DEVELOPMENT UNDER SINGLE OWNERSHIP. 0 IRRIGATION: 3/4", 1", 27:r' QTHEFR: <br /> 0 I AM OPTING TO INSTALL MULTIPLE DOMESTIC WATER 0.FIRE: 't", ?', 4", 6"', (r., OTHER: <br /> SERVICES FOR MY MULTI-FAMILY DEVELOPMENT UNDER 0 DO.MESTIGIFIRE COMBO:.• 1", 2", OTHER: <br /> SINGLE OWNERSHIP .FILL OUT:REVERSE SIDE OF THIS FORM. <br /> • OWNER NAME: Richard Rooney rEt4AIVI°PIAME:{If Commerotai); <br /> OWNER MAILING ADDRESS: STREET 8903 4th Place SE <br /> Grp;Everett STATE WA ZIP 98208 <br /> OWNER PHONE 4-5-330„:442 " . . OWNER EMAIL: <br /> CONTRACTOR NAME: Sposari inc. dba Mr. Rooter Plurnbing <br /> CONTRACTOR ADt1RESS: sT E€;2000 South 116th St . <br /> GnY Seattle STATE WA ZIP 9 m 08 <br /> CONTRACTOR PHONE:206-651-2917 cONTRACToa EMAIL;:charlenel©rnrrooter. .COITI ' <br /> CONTRACTOR LIC.I#(REautR ):MRROOP*022NE ciiv OF EVERETT BUSINESS LIC.#(izEOUI•Rt<'):038080 <br /> PRIMARY CONTACT: ❑OWNER W ^I-id CONTRACTOR a OTHER(Please Specify) <br /> CONTACT NAME: ' CONTACT PHONE:206�i51-2917 <br /> CharlerIe Lundgren CONTACT EMAIL:ChsarIe11:eI@,mrro.,tersea.com <br /> AGREEMENT:The unde sighed applicant agrees to comply with all p•rovisions of'the Everett-AditnicipaI Code;Title, f 4 Watera.,d Sewer or such other rales and regulations how <br /> existing orwhich may belestablished froth time to time.The applicant'artheragrees.as a ditlon precedent to receiving ervice that the utilities divisions shall have the right at any <br /> time,without notice,to shut off or turn on the water supply forrapai.r construction•and nocpaymapt of charges or for arty other reasonakla detise,J em the owner,or lam <br /> earn R ,.d by the owner owner i:f this property:to••erform the work for which ap#tft tlrrtr.to made,and I cortip!y with the State•Centlectors Law 18 271.CW end 296,200A WAC. <br /> / City of Everett Official Use Only <br /> , PERAYII # <br /> 4 u �- <br /> OwnerlAuthorized •4(int SIg, re bate (Revised ?3/2pr6, <br /> i <br />