2224 HOYT AVE 2018-07-25 - Laserfiche WebLink

0 WATER / SEWER UTILITY APPLICATION '411CITY 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 PROJECT SITE INFORMATION PROJECT ADDRESS: 2224 IF APPLICABLE: 0 OUTSIDE CITY LIM S 0 BUILDING AREA SF 0 LOT# BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑DULEX ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL ❑INDUSTRIAL CHANGE OF USE? .N 0 YES, FROM TO UTILITY APPLICATION INFORMATION SEWER(check all that apply) WATER(check all that apply) ) SIDE SEWER REPAIR 0 NEW WATER SERVICE INSTALLATION ❑`SIDE SEWER ALTERATION 0 COMPLETE SERVICE 0 METER ONLY ❑ NEW SIDE SEWER INSTALLATION SERVICE/METER USE: El 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, CONTACT INFORMATION OWNER NAME: clAt. \j© 1VACen TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET 22 ) t ' ° I V `� CITY o f STATEimii z,,4 1 OWNER PHONE: �/ OWNER EMAIL: CONTRACTOR NAME: il4'141- P wifetioi iel 1 CONTRACTOR ADDRESS: STREET / _ CITYSTATE02* •• ZIP a CONTRACTOR PHONE:l.!'[!A 43-012 CO1RACTOR EMAIL:a.A.,,p\IAJ 4 b` l e, I O I i CONTRACTOR LIC.#REQUIRED: CITY OF EVERETT BUSIN LIC.#(REQUIRED): 0 95-1 5514 PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: • CONTACT PHONE: L1T�,'in-16P/„.1 y\1✓ WCi\ VA, CONTACT EMAIL: /� I Kixid I 17 I .0 2 -7,9am IU ,e61,0AGREEMENT:The undersigned applicant agrees to comply with all provisions of the Everett Municipal arode Title City of Everbtt Official Use Only 14 Water and Sewer or such other rules and regulations now existing or which maybe established from time to FEE time. The applicant further agrees, a con.i', precedent to receiving service that the utilities division shall have ^ /�� the right at any ' e,w" t notice,to shut off o turn on the water supply for repairs,construction,and ,//yV) nonpayment•f c :r.-s or or an other reasona.le cause.I am the owner,or I am authorized by the owner of this IV if property top- or he wo i hich applicatio is made,and I comply with the State Contractors Law 18.27 PERMIT# RCW-and 29%,200, - to. l�®qOrl caner/Authoriz •i gent Sig,ature Date (Revised 10/12/2015)