My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
1023 GRAND AVE 2018-09-11
>
Address Records
>
GRAND AVE
>
1023
>
1023 GRAND AVE 2018-09-11
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
9/11/2018 8:48:53 AM
Creation date
9/11/2018 8:48:53 AM
Metadata
Fields
Template:
Address Document
Street Name
GRAND AVE
Street Number
1023
Imported From Microfiche
No
There are no annotations on this page.
Document management portal powered by Laserfiche WebLink 9 © 1998-2015
Laserfiche.
All rights reserved.
/
4
PDF
Print
Pages to print
Enter page numbers and/or page ranges separated by commas. For example, 1,3,5-12.
After downloading, print the document using a PDF reader (e.g. Adobe Reader).
View images
View plain text
400, ATE / SEWER Lr TILITY APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: ( d 23 Gya;pld 4Ue cc/we <br /> IF APPLICABLE: 0 OUTSIDE CITY LIMITS 0 BUILDING AREA SF 0 LOT# <br /> BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑DULEX IIMULTI-FAMILY#OF UNITS: ❑COMMERCIAL ❑INDUSTRIAL <br /> CHANGE OF USE? El NO 0 YES, FROM TO <br /> UTILITY APPLICATION INFORMATION <br /> SEWER(check all that apply) WATER(check all that apply) <br /> W SIDE SEWER REPAIR 0 NEW WATER SERVICE INSTALLATION <br /> ❑SIDE SEWER ALTERATION 0 COMPLETE SERVICE 0 METER ONLY <br /> ❑ NEW SIDE SEWER INSTALLATION SERVICE/METER USE: <br /> ❑ INSTALL BACKWATER VALVE(outside the building) 0 SFR <br /> ❑SIDE SEWER CAP-OFF 0 MULTI-FAMILY-#OF UNITS: <br /> ❑SIDE SEWER RECONNECTION 0 COMMERCIAL <br /> MULTIPLE DOMESTIC WATER SERVICES REQUEST WATER SERVICE TYPE/SIZE:(circle desired size) <br /> ❑I AM DECLINING MULTIPLE DOMESTIC WATER SERVICES FOR 0 DOMESTIC: 3/4", 1", 2", OTHER: <br /> MY MULTI-FAMILY DEVELOPMENT UNDER SINGLE OWNERSHIP. 0 IRRIGATION: 3/4", 1", 2", OTHER: <br /> ❑ I AM OPTING TO INSTALL MULTIPLE DOMESTIC WATER 0 FIRE: 1", 2", 4", 6", 8", OTHER: <br /> SERVICES FOR MY MULTI-FAMILY DEVELOPMENT UNDER 0 DOMESTIC/FIRE COMBO: 1", 2", OTHER: <br /> SINGLE OWNERSHIP.FILL OUT REVERSE SIDE OF THIS FORM. <br /> CONTACT INFORMATION <br /> OWNER NAME: A UL- A R f -k G�. - TENANT NAME(If Commercial): <br /> to 23 <br /> OWNER MAILING DRESS: sTREEr &/ , 4 Jc <br /> CrYY Cue 1 jf STATE V`) A ZIP i pr) ' <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: Cosoi e <br /> CONTRACTOR ADDRESS: sTREET 4/63 0 (6 /c-2 £_ si E 13 -9 / <br /> CITY Fire— <br /> re— STATE CA 1 A ZIP ?Re/.2 Y <br /> CONTRACTOR PHONE: ? !e):• .J" $6 7t5 C ONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED) i OfSa 2_ P CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONT CT NAME: CONTACT P NE ` , 2�Q L <br /> e6 4 Q 7 <br /> CONTACT Eh�FfC J J <br /> AGREEMENT:The undersigned applicant agrees to comply with all provisions of the Everett Municipal Code Title City of Everett Official Use Only <br /> 14 Water and Sewer or such other rules and regulations now existing or which may be established from time to FEE <br /> time.The applicant further agrees,as a condition precedent to receiving service that the utilities division shall have l] j <br /> the right at any time,without notice,to shut off or turn on the water supply for repairs,construction,and '�,/h1V) <br /> nonpayment of charges or for any other reasonable cause.lam the owner,or 1 am authorized by the owner of this <br /> property to perform the work for which application is mad- -•.I comply with the State Contractors Law 18.27 FERMI- <br /> 1_1f,and 296.200A WAC. / , �� <br /> b5 b <br /> Owner/Authorized Agent Srurjrirjr�• Date (Revised 10/12/2015) <br />
The URL can be used to link to this page
Your browser does not support the video tag.