2017 WALNUT ST 2018-07-19 - Laserfiche WebLink

4:en. WATER / SEWER UTILITY APPLICATION t-Aa° 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 1 a £: V r ;. ,F P OJECT SItkli fPRMATIONfhi d.._.F. kmak. , ' .:. _ PROJECT ADDRESS: 72 1 7 t z/-i,d¢i7t4 -fir IF APPLICABLE: 0 OUTSIDE CITY LIMITS 0 BUILDING AREA SF 0 LOT# BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑DULEX ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL ❑INDUSTRIAL CHANGE OF USE? 0 NO 0 YES, FROM TO 1T. ., .._ UTILITY 00:41#1;O:N INFORMATION . . i ' R , SEWER(check all that apply) WATER(check all that apply) /[J 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 ❑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 FORMS i7 .. : : _: . -. i': is ,40:014-0-INFORMATION ,, , . , . , ..:,,,',:s! OWNER NAME: C-61-14/ 'Q[) /c Ir' TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET S R eiL CITY STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: Rob" (2Yl-eC v t CONTRACTOR ADDRESS: STREET /06 J--5 TiLf kV"/ 1 4f6 Tut r CITY u V., STATE C I t l�1G/ZIP ( O+36 CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED): fjc) QC iza6R. CITY OF EVERETT BUSINESS LIC.#(REQUIRED):0 SZ.7 2.€1PRIMARY CONTACT: ElOWNER CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: fl Z 5- 3 y(p OG a7 1 N.5 CONTACT EMAIL: ,AGREEAGREEMENT: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 may be established from time to FEE zo 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 cha o es or for any other reasonable cause.I am the owner,or I am authorized by the owner of this property to•- = - *— :=--- tion is made,and I comply with the State Contractors Law 18.27 PERMIT# RCW and 296.200AWAC. ! Z3 u t Q O3 —039 J 0 2 9 Owner/Authorized Agent Signature ate (Revised 10/12/2015)12