3515 OAKES AVE 2022-05-04 - Laserfiche WebLink

W� ,ATE / SEWERUTILITY APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 I FAX 425-257-8857 1 (E) everetteps@everettwa.gov 1 www.everettwa.gov/permits PROJECT SITE 1NF®RMATION PROJECT ADDRESS: 1616 OI, . 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? 1_10 0 YES, FROM TO UTILITY APPLICATION INFORMATION SEWER(check all that apply) WATER(check all that apply) ❑SIDE SEWER REPAIR 0 NEW WATER SERVICE INSTALLATION ❑SIDE SEWER ALTERATION 0 COMPLETE SERVICE 0 METER ONLY ❑ NEW SIDE SEWER INSTALLATION SERVICE/METER USE: lit INSTALL BACKWATER VALVE(outside the building) 0 SFR ❑SIDE SEWER CAP-OFF 0 MULTI-FAMILY-#OF UNITS: CI SIDE SEWER RECONNECTION 0 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: SERVICES FOR MY MULTI-FAMILY DEVELOPMENT UNDER 0 DOMESTIC/FIRE COMBO: 1", 2", OTHER: SINGLE OWNERSHIP. FILL OUT REVERSE SIDE OF THIS FORM. CONTACT INFORMATION OWNER NAME: tim,. 4....lia I 14 ,t�� ,L.�j v `', TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET bO 1 0 c A/ - lit W) cm( CelAit4?-€ STATE 'ANA ZIPql, OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: A°A- P,atki, CONTRACTOR ADDRESS: STREETeAtord ' 1 G., ie • CITY STATE Wek, • ZIP CONTRACTOR PHONE:(J42 )LQOt CONTRACTOR EMAIL: 4\I,A,y VFl tile, �✓'Il 01 I i CONTRACTOR LIC.#(REQUIRED) t P CITY OF EVERETT BUSINYE3S UC.#(REQUIRED) (_ PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: . CONTACT PHONE: (,14#A..4.) 122'—q-12d ril6 YV` 1 Y�"l Y 1✓ CONTACT EMAIL: A1 Imh id I 17 t IIs Vil®11(WAAI •AGREEMENT.The undersigned applicant agrees to comply with all provisions of the Everett Municipal de Title City of EveOfficial Use Only 14 Water and Sewer or such other rules and regulations now existing or which may be established from time to FEE time. The applicant further agrees, a coni 'n precedent to receiving service that the utilities division shall have Tl �D I the right at any ' e,w' • t notice,to shut off o turn on the water supply for repairs,construction,and nonpayment. ch'r•-s or or an other reasona,le cause.I am the owner,or!am authorized by the owner of this property top or he wo • hich applicatio is made,and I comply with the State Contractors Law 18.27 PERMIT# RCW and 29:200 WAC ,, , To posTml.ir. i. u ,(6061-0[1iii 1)(\iwner/Authoriz•�•gent Sigeature Date (Revised 10/12/2015)