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WA, TER SEWER UTILITY APPLICATION <br /> ON <br /> r a CITYOF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVEIETT,WA 98201 <br /> (P)425,257-8810 I FAX 425-257-88 7 "i(E)everettep everettwa.gr�v 1 www eve tt ra.go dpermits <br /> h'i`� a' s, .< r r`>.:.F e `" • <br /> Pr OJE T ADDRESS.2122.W Mtikitceo Blvd, Everett,WA 98203 <br /> II=APPLICABLE: ©OUTSIDE CITY LIMITS Ll BUILDING AREA D LOT# <br /> BUILDING TYPE: OSFR-DETACHED USFR lTTACHED 1:IDULEit EIMULTI-FANIILY4.OF.UNITS: _ CICOMMERCIAL DINDUSIRIAL <br /> CHAN .: . <br /> OF USE? D NO D YES, FROM TO <br /> $I LIKE.-(c3 all"that apply): WATER(check all.that apply) w ti3 <br /> .0 SIDSEWER R <br /> EEPAIR CI NEW WATER SERVICE INSTALLATION <br /> Cl SIDE-SEWER ALTERATION El COMPLETE SERVICE 0 METER ONLY <br /> D NEW IDe-ZEWER:1N8TALt ATION SERVICE[METER USE: <br /> • <br /> CI INSTALL BA K A E VALVE(outside the'building) C SFR <br /> D$IDE•SEWER CAP-OFF ©MULTI-FAMILY-#';OF UNITS: <br /> C7 SIDE$a.i -,RECQNNECT1ON ID COMMERCIAL <br /> MULTIPLE DOM STIC WATER SERVICES RE IUIRST WATER SERVICE TYPE/SIZE (circle desired size) <br /> Cl IAM DECLINING MULTIPLE DOMESTIC WA' ER"SERVICES FOR D DOMESTIC: WO, 1""> ', OTHER: <br /> MY MULTI=FAMILY 13EVELOPMENT'UNDER SINGLE OWNERSHIP 0 If2RIGATION: 3/4", 1", 2", OTHER: <br /> ❑I.AM OPTING TO INSTALL MULTIPLE DOMESTIC WATER LI FIRE: 1", 2", 4", •6", S OTHER: <br /> SERVICES FOR MY:MULTI-FAMILY'DEVELOPMENT.UNDER D DOMESTIC/FIRE COMBO 1«f 2•, { HER <br /> - r <br /> SINGLE OWNERSHIP.FILL°III-REVERSE SIDE:OF THIS FORM <br /> • <br /> a,+ <. <br /> =w .� ... .„ �£ " ,, <br /> QWNER NAME: Francis-LOrent2 TENANT NAME(If Commercial): <br /> OWNER MMLNG ADP S 2322 W Mukilteo Blvd <br /> Everett r�, we 98203 <br /> oWNE> PHONE 425.589.42141: OWNER ENINL hflorentz a@m <br /> yahoo co <br /> CONTRACTOR NAME„_,(;ameronS One LLC:dba NW Sewer& Drain <br /> CONTRACTOR ADORES* siREET PO.BOX 55573 <br /> ho eline <br /> STATE WA zp 98155 <br /> coNTRACToRPHosES"perle4 C-hynowetn CONTRACTOREMAIL:spencer( fwsewer,com <br /> CONTRACTOR Lir,#(REAL I�REt3} i EWSD8E P.B OF EVERETT BUSINESS ticIRED.31:53782 <br /> 'PRIMARY COlflTACT-- ErowNER, EI CONTRACTOR f;4-OTHER(Please Specify)'Etna'kkPPpe'r <br /> CONTACT NAND CONTACT PHONE 206.931.7728 <br /> Jessica <br /> CONTACT }essrc�I rtws ae rL ;cam <br /> AGREEMENT:Th idersipned applicant egreas te-comply with.all provrsrens ofthe Everett h#rnicpat code rr8e 1.1'1/voter and Sewer or such:ottrerm/esrand regulations-now <br /> existing or which may be established hor-tlrrie to lime.The•s llcent rat a as a condition precedent to receiving serviee that the utilities dhrlsion ahall havefheo rigid at any <br /> Elms,without not{ce to shut efl`c film the wstet sappfyrormpafrs;aornstnicbon;,and nonpaymentofi harges=odor' y other reasonable cause.l am the.owner,or ata: <br /> authorized by the ownarofthis:pmperry to parfot�th the work for whiahappikation is made,and t comply With the State COnt tern taw 18'27 fiCW and 296:200A WAC <br /> City of Everetttticfa/Use Only <br /> PERMIT# <br /> Jessica Thres Q5/1612013 <br /> 0wnsrtA rth6ifzed-/Agant;Sigt�atute. • bate jRevserf:9i2312016) <br />