2118 46TH ST SE 2018-07-27 - Laserfiche WebLink

WATER , SEWER UTILITY APPLICATION 1,11°;----A 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 PROJECT,SITE INFORMATION PROJECT ADDRESS: Ill 1 ? L4 09 qT. 65 IF APPLICABLE: 0 OUTSIDE CITY LIMITS 0 BUILDING AREA SF 0 LOT# BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED 0 DULEX ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL 0 INDUSTRIAL CHANGE OF USE? Yil.\12. ❑YES, FROM TO UTILITY APPLICATION INFORMATION. ' SEWER(check all that apply) WATER(check all that apply) 0 SIDE SEWER REPAIR ❑ NEW WATER SERVICE INSTALLATION 0 SIDE SEWER ALTERATION 0 COMPLETE SERVICE 0 METER ONLY ❑ NEW SIDE SEWER INSTALLATION SERVICE/METER USE: ❑ INSTALL BACKWATER VALVE(outside the building) ❑SFR 0 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 ❑ DOMESTIC: 3/4", 1", 2", OTHER: MY MULTI-FAMILY DEVELOPMENT UNDER SINGLE OWNERSHIP. 0 IRRIGATION: 3/4", 1", 2", OTHER: 0 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: tC/61 Uv 1 1 1 i aY l IS TENANT NAME(If Commercial): ' OWNER MAILING ADDRESS: STREET .1 L til �vg -).-s. • Se) � CITY STATE h ZIfi�I�.0 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: Pi rY P[Imiiitio re CONTRACTOR ADDRESS: STREET t Y CITY STATE OA b • ZIP �.....,w _,r .�"�... O f3 CONTRACTOR PHONE: ]423 �v CO� ACTOR EMAIL: AW i1 IC V°11 Opal, I.!O4 CONTRACTOR LIC.#RE UIRED: 1,4,11.0„4151t b CITY OF EVERETT BUSIN LIC.#(REQUIRED): 5iwi,..._.�. PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: • CONTACT PHONE: (-19 22 "l'V 1 t r 6 1► 6�� l k\ CONTACT EMAIL: /� ( ��A C +C -,•-ia n O a 44 A( .04444 • AGREEMENT : undersigned applicant agrees to comply with all provisions of the Everett Municipal de Title I "�' City of Ever I t 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, a con.! 'n precedent to receiving service that the utilities division shall have 4 �0 1l;/ the right at any ' e,w' • t notic ,to shut off o turn on the water supply for repairs,construction,and nonpayment. oh, •-s or or an other reasona.le cause.I am the owner,or I am authorized by the owner of this property top- or he wo h applicatio is made,and I comply with the State Contractors Law 18.27 PERMIT#01 / ! ` RCW and 29:200• jACk ko u �I /� O+ V" Owner/Authoriz 4•gent Sig'ature Date (Revised 90/92/2015)