|
' . ' WA TER I SEWER UTILITY A.PR.h.IGATiON
<br /> >�, • CITY OF EVERETT PERMIT SERVICES
<br /> 0Q CEDAR.STREET,:EVERETT,U to S$201
<br /> • (P)425-25?••=881 - FAQ A 5- 7.88 7 I I)everetteps-04. gc3V;i =www VerettWa.gr v/#arm is
<br /> .S,n .,'i M . ...•..., �.a4i�..a, 'na; � w?N,, �Tr � a..�.` ` -„ 3,xte" . . a.{5,.,` \ -w
<br /> PROJECT ADDl2E,2517 Oakes Ave
<br /> tF•APPLICABLE• D OUTSIDE CITY LIMITS• D'SUIIiDING AREA •. SF 3 LOT#
<br /> BUILDING TYPE @SFR DE to HEi� [ FR ATTACHEI C DULE•.x DMU-Ltl:..AMILY OF UNITS:.'. ., O•COM ERC AL 0lNb STI IAL.,s. . ."•,,::
<br /> :
<br /> CHANGE OF ©NO D YES, FROM TCT
<br /> • s k'USE? .1 seer' r�� � . i ` ,,,,,7,„7.,,,,,,t,;,„„., ® �," ,: . ft ya. - „,
<br /> •
<br /> .
<br /> SEWER•(heck aN that Spply)
<br /> till I ER(check all 1 Stapply)
<br /> 0 SIP?E SEWER REP AIR D NEW WATER SERVICE INSTALLATION
<br /> D•SIDE-SEWER ALtERATION 0 COMPLEtE SERVICE..; ' 0 METER ONLY
<br /> •
<br /> D NEW,SIDE SEWER INSTALLATION SERV•ICE t • .•.• SEs,
<br /> DRDINSTALLBACKWATERVALVE(ousidethe buIldng) F
<br /> SIDESEWER CAP-OFF UMULTI=FAMILY-#OF.UNITP,
<br /> D SIDE SEWER RECONNECTION D COMMERCIAL
<br /> MULTIPLED STIC ATERfRVICES'REQUES i WATER SERVICE TYPE LSIZE::(cIrcle rdesired:si2e')
<br /> Dl.AM DECLINING-.MULTIPLE DOMESTIC WATER SERVICES Fofk, ...C1. •::00.. MESTIC; 8/4, `C"t ? OTHER;
<br /> MY MULTI-FAMILY DEVELOPMENT UNDER"SINGLE OWNERSHIP. ©IRRIGATION, 3I4'"g - 1'; „:2....,....,,,,
<br /> 2", OTHER:
<br /> o I AM OPTING TO IIISTALL MULTIPLE DOMESTIC WATER SIRE: 1" 2” 4". 6"`: --•-•87,-;::::07•178. P'''.E
<br /> SERVICES FOR MY MULTI-FAMILY DEVELOPMENT UNDER D DOMESTIC/FIRE COMBO: 1", 2' OTHER:
<br /> SINGLE OWNERSHIP.,FILL OUT REVERSESIDE=OF Tills FORM:
<br /> oW Ef NAME' ChIis Contact TENANT NAME(t;C6mmerciat);
<br /> OWNER MAILING ADDRESS: srReEr 251.7 Oakes Ave
<br /> •
<br /> Everett 1 W ,a•9
<br /> 8201 . �.
<br /> OWNER PHONE 206H786*1858 DOWNER EMAIL, .. ,,.. , ... ,..., . , , .. : . , ,
<br /> r CONTRACTOR 1;A-iiiSposari lnc dila 1r. Rooter
<br /> CONTRACTOR ADDRE 33: • ,�� ,2000 SaUU 116th St
<br /> cm 3ottle STATE•111fiaA zp 98158
<br /> CONTRACT ?R PHONEi 206-651 2917 CONTRACTOR EMAIL, ch�atleriei f mrrooterseaRcOm
<br /> „c
<br /> CONTRACTOR LIC i tREQUIRED}MRt OC P*022NE cn v of EYEf�E7 t BUSINESSUC REou1REb} 038080
<br /> PRIMARY'GONTACt DOWNER ,'Ea...-..c. ONTRACTQR 9 GATHER-{Meese Specify) ,
<br /> CONTACT NAME CONTACT PHONE:206 51-2 4
<br /> 'C1harlene Lu dgren 1CO •TACT EMAIL:Gharlenel rnrrootersea,corn
<br /> AGREEMENT Fhe unde Yt/r ed a?rpile nt to conlplytytth all prpvislons otth"e Liven tt AAunlclpal Code Title 14 Water'sncl S6'er or`auch'other rites altd regulaUons'plo
<br /> axis#Ing orWhlch maybe est bllshed from:t7felTh9::*!;ionvt::tritn:th.
<br /> e,The eppiloant Mther agrees.as a condi precedent ttrrecelvirlg setvio thailhe utilities dMslon shall have the Yght st any
<br /> time,without notice;to situ#otf oir turrt on'tsupply for,repelrs,stns#ruo ,h,and nonpayment of charges'or For any other reasonaklle cause;,.,1
<br /> ai'.the owner,or i am
<br /> aufhtrnza/.by the owner iM thie proper!k t•, e w riel which application.Is nttrda.and!comply w li Elie State Ctitl clot L )t 18.27 RCWanrt 296 200A WAG..
<br /> ,t Ity of Everett.0171::279,,0,01:Q
<br /> lel iJse fln
<br /> PERMIT
<br /> ftp L
<br /> Owns Authorize d A>ant Sig,,to a1 Date (Revisers Wl2812016)
<br />
|