805 94TH ST SE 2018-06-12 - Laserfiche WebLink

� � ^ W�� / �� I�I�� '�/��'� CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 (P)425-257-8810 � FAX 425-257-8857 � (E) everetteps@everettwa.gov � www.everettwa.gov/permits PROJECT SITE INFO.RNIATIOI�1 ; � ti,. .. . ; ._. _.or _...,,._ , PROJECT ADDRESS: � �1 � l�APPLICABLE: ❑OUTSIDE CITY LIMITS ❑ BUILDING AREA SF ❑ LOT# BUILDINGfiYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑DULEX L7'MULTI-FAMILY-#`OF UNITS: ❑COMMERCIAL ❑INDUSTRIAL CHANGE OF USE? NO ❑YES, FROM TO � , � - .� '`` UTILITY APPLICATION INFORN6ATION � SEWER(check all that apply) ' WATER(check all that apply) �(SIDE SEWER REPAIR ❑ NEW WATER SERVICE INSTALLATION ❑SIDE SEWER ALTERATION ❑COMPLETE SERVtCE ❑METER ONLY ❑ NEW SIDE SEWER INST/�LLATION SERVICE/METER USE: �INSTALL BACKVI/ATER VALVE oufside the building) ❑ SFR ❑SIDE SEWER CAP-OFF ❑ MULTI-FAMILY-#OF UNITS: ❑SIDE SEWER RECONNEGTION ❑COMMERCIAL MULTIPLE DOMESTIG VIIATER SER1/10ES REQUEST WATER SERVICE TYPE/SIZE:(cirele desired size) ❑ I AM DECLINING MULTIPLE DOMESTIC WATER SERVICES FOR ❑ DOMESTIC: 3/4", 1", 2", OTHER: MY MULTI-FAMILY DEVELOPMENT UNDER SINGLE OWNERSHIP. ❑ �RRIGATfON: 3/4", 1", 2", OTHER: ❑ I AM OPTING TO INSTALL MULTIPLE DOMESTIC WATER ❑ FIRE: 1", 2", 4", 6", 8", OTHER: SERVICES FOR MY.MULTI-FAMILY DEVELOPMENT UNDER _p DOMESTIC/FIRE COMBO: 1", 2", OTHER: SINGLE OWNERSHIP. F/LL OUT REVERSE SIDE OF THIS FORM. ' CONTACT INFORMATION OWNER NAME: , D TENANT NAME(If CommerciaQ: OWNER MAILING ADDRESS: STREET � o` � C17Y STATE ZIP � OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: CONTRACTOR ADDRESS: srRee-r • CITY STATE A • ZIP CONTRACTOR PHONE: CO 7RACTOR EMAIL: l CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSIN LIC.#(REQUIRED). O _...,�. __....�.��a. ....n..�.�.ri,a.„ r �_„�,..�s.� ,.,,_ _ PRIMARY CONTACT: ❑OWNER ❑GONTRACTOR ❑OTHER(Please Specify) � CONTACT NAME: � '- CONTACT PHONE: � ` '2�— CU1,��5 UV`�`� �'4�,�'�' - - V CONTACT EMAIL: � � c � � , AGREEMENT:The undersigned applicant agrees to comply with all provisions of the Everett Municipal de Tit/e City of Ever O�cial 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 furtheragrees, a con i' precedent to receiving service that the utilities division sha/!have � � the right at any ' e,w' t notic ,to shut off o turn on the water supply for repairs,construction,and ,� nonpayment ch r s or or an other reasona le cause.1 am the owner,or I am authorized by the owner of this property to p or he wo hich appiicatio is made,and I comply with the State Contractors Law 98.27 PERMIT# RCW and 29 200 WAC � �� /�/'_ �� �� wnerlAuthoriz gent Sig ature Date (Revised 90/92/2095)