2020 78TH PL SE 2018-07-20 - Laserfiche WebLink

47.7. Vier—ER / SEWER UTILITY 40,PLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 I FAX 425-257-8857 1 (E)everetteps@everettwa.gov E www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: W eitte fk, Se Eife (A k IF APPLICABLE: 0 OUTSIDE CITY LIMITS 0 BUILDING AREA 9 S ao SF 0 LOT# BUILDING TYPE: 9 SFR 0 MULTI-FAMILY 0 COMMERCIAL . 0 INDUSTRIAL - CHANGE OF USE? 14NO 0 YES, FROM TO UTILITY APPLICATION INFORMATION SEWER(check all that apply) WATER(check all that apply) ❑SIDE SEWER REPAIR ++ EW WATER SERVICE INSTALLATION ❑SIDE SEWER ALTERATION 0 COMPLETE SERVICE IKMETER ONLY ` VE/l/SIDE SEWER INSTALLATION SERVICE/METER USE: ❑INSTALL BACKWATER VALVE(outside the building) yCSFR ❑SIDE SEWER CAP-OFF 0 MULTI-FAMILY-#OF UNITS: ❑SIDE SEWER RECONNECTION 0 COMMERCIAL MULTIPLE DOMESTIC WATER SERVICES REQUEST WATER SERVICE TYPE f SIZE:(circle desired size) ❑1 AM DECLINING MULTIPLE DOMESTIC WATER SERVICES FOR 0 DOMESTIC: 3/4", 1", 2", OTHER: MY MULTI-FAMILY DEVELOPMENT UNDER SINGLE OWNERSHIP. ❑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 "14 DOMESTIC/FIRE COMBO: 0 2", OTHER: SINGLE OWNERSHIP.FILL OUT REVERSE SIDE OF THIS FORM. CONTACT INFORMATION OWNER NAME:/41,,,,c f7P/cfl„f c &LC- TENANT NAME(If Commercial): OWNER MAILING ADDRESS: sTREEr /?-O $CLI SC.r E-k- /00 • CITY FL/eV-C- STATE jaw( ZIP q OWNER PHONE: `45 3 -- oz300 OWNER EMAIL: v./44i 1. S wry pc=t iS . C d'Y► CONTRACTOR NAME: Sec; 3c L o vat,e 5 CONTRACTOR ADDRESS: STREET I O 5 f L' (,. fi4 ra/( G(,,J .?'p '5 c t.t`int /Q 13° ccm, E V es 1 STATE �i�' ZIP 3 a'f CONTRACTOR PHONE 0)5- '153- ez 5 bd CONTRACTOR EMAIL: VLJ WWI `j e, 4 4,L c m e S co`v► CONTRACTOR LICENSE#(REQUIRED): =/IPAN155e; C. `7 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):05a33 PRIMARY CONTACT: ❑OWNER In CONTRACTOR %OTHER(Please Specify) CONTACT NAME: y CONTACT PHONE: /..0.5/..0.5— 3)S --�y 3 0 } STT105-e ri6A-(1-- CONTACT EMAIL: mQi-, (-0 5e4p L-i1 GN1 es. Cam 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 may be established from time to FEE 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 tum on the water supply for repairs,construction,and 1,Q16'-oz nonpayment of charges or for any other reasonable cause.tam the owner,or I am authorized by the owner of this property to perform the work for which application is made,and 1 comply with the State Contractors Law 18.27 PERMIT# RCW and 296.200A WAC. I —(s / * ■ I 02\ ncri y u Owner/Authorized Agent Signature Date (Revised 09/25/2016)