1520 W MARINE VIEW DR 2018-12-21

4,77, WA / SEWER UTILITY APPLICATION 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 .P'RE' JECT 1NFORMATtON PROJECT ADDRESS: (5 2© lelLTST MMINE- NICU Ua- 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 SEWER(check all that apply) WATER(check all that apply) ❑SIDE SEWER REPAIR (oJ NEW WATER SERVICE INSTALLATIONTI ❑SIDE SEWER ALTERATION 0 COMPLETE SERVICE L�METER ONLY ❑NEW SIDE SEWER INSTALLATION SERVICE/METER USE: ❑ INSTALL BACKWATER VALVE(outside the building) 0 SFR Et SIDE SEWER CAP OFF 0 MULT-r-FAMILY-#OF UNITS: ❑SIDE SEWER RECONNECTION IJ 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: SE'RVI'CESFOR`MY MULTI=PAMILYDEVELOPMENT U R DOMESTIC/FIRE COMBO: 1", 2", OTHER: an SINGLE OWNERSHIP.FILL OUT REVERSE SIDE OF THIS FORM. OWNER NAME: c2pCc p F' Ev�61�'("( TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET L 1 in-f j C.7.45jMAi, � "kl 6y " * 20c) CITY' C.�I ' 1- STATE V.I.A ZI 9620 ,, OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED) CITY OF EVERETT BUSINESS LIC.#(REQUIRED) PRIMARY CONTACT: OWNER ❑ CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 3.6,9— 052- 70712 W111►I:. tiJ CONTACT EMAIL: '44 p ?ociaraveurt.com AGREEMENT:The undersigned applicant agrees to comply with all provisions of the Everett Municipal Code Title 14 Water and Sewer or such other rules and regulations now existing or which maybe established from time to 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 wafer supply for repairs,construction,andhonpaymentof charges or for any other reasonable cause.ram the owner,or I"am authorized by the owner of this property to perform the work for which application is made,and I comply with the State Contractors Law 18.27 RC W and 296.200A WAC. City of Everett Official Use Only PERMIT# 6„ oVo/7 U i10(D 4�Owner/Authorized Agent Signature (Revised 9/23/2016)