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WATER I SEWER UTILITY APPLICATION <br /> 74410/"- 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 1 WWw.everettwa.govtperrnits <br /> O0` "ll`�.' TE;>M 4 <br /> PROJECT ADDRESS: 1323 McDougall Ave <br /> IF APPLICABLE; 0 OUTSIDE CITY LIMITS 0 BUILDING AREA SF R LOT# <br /> BUILDING TYPE; eISFR-DETACHED ❑SER-ATTACHED DOULEX>❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL DINDUSTRIAL <br /> CHANGE OF USE? r:11•10 D YES, FROM TO <br /> SEWER(check all that apply) WATER(checkall that apply) <br /> 0 SIDE SEWER REPAIR ❑NEW WATER SERVICE INSTALLATION <br /> D SIDE SEWER ALTERATION 0 COMPLETE SERVICE 0 METER ONLY <br /> D NEW SIDE SEWER INSTALLATION SERVICE 1 METER USE: <br /> D INSTALL BACKWATER VALVE(outside the building) 0 SFR <br /> 0 SIDE SEWER CAP-OFF D MULTIFAMILY-#OF UNITS: <br /> 0•SIDE SEWER RECONNECTION 0 COMMERCIAL <br /> MULTIPLE DOMESTIC WATER SERVICES REQUEST WATER SERVICE TYPE/SIZE:(circle desired size) <br /> 0 I AM DECLINING MULTIPLE DOMESTIC WATER SERVICES FOR 0 DOMESTIC: 3/4", 'ii', 2", OTHER: <br /> MY MULTIFAMILY 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 DOMESTICIFIRE COMBO: 1", 2", OTHER: <br /> SINGLE OWNERSHIP.FILL OUT REVERSE SIDE OF THIS FORM. <br /> ;; z; CONI ACT INFORMATION' <br /> OWNER NAME: Sharon Dehaan TENANT NAME(It Commercial); <br /> OWNER MAILING ADDRESS: STREET 1323 McDougall Ave <br /> arrY Everett STATE WA zip 9820`1 <br /> OWNER PHONE:425-422-7027 OWNER EMAIL: Skdehean2008@hotmail.cOm <br /> CONTRACTOR NAME: Sposari inc. dba Mr. Rooter Plumbing & Heating <br /> CONTRACTOR ADDRESS: STREET 2000 South 116th St <br /> CITY Seattle SSATE WA ZIP 98201 <br /> CONTRACTOR PHONE:206-651-2917 CONTRACTOR EMAIL: charlotte!a mrrootersea.Com <br /> CONTRACTOR LIC.#(REQUIRED): R OOP*O22NE CITY OF EVERETT BUSINESS LIC.#(REQUIRED):038080 <br /> PRIMARY <br /> �..... ...:.... <br /> CONTACT: 0 OWNER la CONTRACTOR ©OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:206-651-2917 <br /> Charlene Lundgren CONTACT EMAIL: charlenel c@x mrroOtersea!corn <br /> AGREEMENT:The undersigned applicant agrees to eomply:with all provisions of the Everett Municipal Code Title 14 Water and Sewer or such other rules and regulations now <br /> existing or which may be 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 <br /> time,without notice,to shut off or turn on the water supply for repairs;,construction,and nonpayment of charges or for any other reasonable cause.I am the owner,or I am <br /> 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 RCW and 296.200A WAC. <br /> /Ciity oof Everett Official Use Only <br /> /O <br /> Owner!' thorized Ag-ht Slgna,t Date (Revised 9/23/2016) <br />