2002 RUCKER AVE 2018-07-19 - Laserfiche WebLink

alomp WATER / SEWER UTILITY APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps©everettwa.gov I www.everettwa.gov/permits ,mak <.r..,, ::r. Etta� __._ _, i � _ _� a _ _ _ �,� �. ..tee .. _ � PROJECT ADDRESS: 4 IF APPLICABLE: 0 OUTSIDE CITY LIMITS 0BUILDING AREA SF 0 LOTS - BUILDING TYPE: ❑SFR-DETACHED l R-ATTACHED_ ❑DULEX ❑MULTI-FAMILY-#OF UNITS:__ I COMM.ERCIAL ❑IND.U.STRIAL CHANGE OF USE? t7 NO 0 YES, FROM TO ...._ Esc ts ;��,. .,r•. �.... liTY.,A 17 ICAT1 NIFC1111 CON yri��'�•.�4: :1f 7,.. ....A_� SEWER(check all that apply) WATER(check all that apply) I'SSIDE SEWER REPAIR 0 NEW WATER SERVICE INSTALLATION ❑SIDE SEWER ALTERATION 0 COMPLETE SERVICE 0 METER ONLY ❑NEW SIDE SEWER INSTALLATION SERVICE/METER USE: 0 INSTALL BACKWATER VALVE(outside the building) 0 SFR ❑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. s OWNER NAME. . ael TENANT NAME(f Commerciat); OWNER MAILING ADDRESS: STREET „12(7)02, ,,, .v " cnY, +" STATE kin zap et. OWNER PHONE ii2'5561 7J OWNER EMAIL: ¢ sco' . CONTlA1~TORNAME I '. `. .( r. . arxxitte- a. CONTRACTOR ADDRESS: STREET ;KW Sk CRY} 1l' "' STATEIVif3' ZIP 4)'1 ,�_' CTRACTOR PHONE 2 & " 2I CONTRACTOR EMAIL: t 1 t _ - it ~ri ` i • �. : CONTRACTOR LIC. . : 4 me ,, : � -62,26F;.;; CITYOF EVERETT BUSINESS LIC.IR EE IUIRE? 5 - PRIMARY CONTACT: 0 OWNER I 0LNTCTOR ❑OTHER(Please Specify) - fyi rrOci ., AAV NAME: CONTACT PHONE: CONTACT EMAIL: ` N AGREEMENT.The undersigned applicant agrees to with all provisions of the Everett Municipal Code Title 14 Water and Sewer or such other rules and regulations now existing or which maybe established from time to 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,to shut off or turn on the water supply for repairs,construction,and nonpayment of charges or for any other reasonable cause.lam the owner,or!am 4, by the owner of this property .,perform the work for which application is made,and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett,Official.Use Only r PERMIT# . ; e �t ,ce0(.4 — Oio owneouth. . Agent•S . Still* Alf e.t (Revised 9/23/2016)