2316 7TH ST 2019-01-30 - Laserfiche WebLink

WATER / SE EL' 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 PIS®JECT SITE INFORMATION ; PROJECT ADDRESS: 2 3 I to -It"St. 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? clEI NO 0 YES, FROM TO UTILITY APPLICATION,INFORMATION ,. SEWER(check all that apply) WATER(check all that apply) ASIDE SEWER REPAIR 0 NEW WATER SERVICE INSTALLATION ❑ SIDE SEWER ALTERATION 0 COMPLETE SERVICE 0 METER ONLY ❑ NEW SIDE SEWER INSTALLATION SERVICE/METER USE: ❑ INSTALL BACKWATER VALVE(outside the building) 0 SFR ❑ SIDE SEWER CAP-OFF 0 MULTI-FAMILY-#OF UNITS: ❑ 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: tit i a Sn th �i "14' ( TENANT NAME(If Commercial): L OWNER MAILING ADDRESS: STREET 3 j(Q 7 `,. J� ' Q CITY Eve- -,� CO G STATE C ZIP q V 2.01 OWNER PHONE: 206 ^ 5•((- liqZt1 OWNER EMAIL: III VISliaMI ht. i COM CONTRACTOR NAME: Shu eAr frreinCIA CONTRACTOR ADDRESS: STREET CITY Shore li STATE k"CA ZIP CONTRACTOR PHONE: 20co' jO-7189) CONTRACTOR EMAIL: infO@SCWc.rf,`en Elly,CO WI /� CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 1)11 1"I CONTRACTOR LIC.#(REQUIRED); �OZ��V PRIMARY CONTACT: WNER 4CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME_ t CONTACT PHONE: Z O(p - -i 7(p -0 (4 7 I NI EV/ \ ''lo \ s J 1 CONTACT EMAIL: tY1,€41-.'ilip„v�CCoy)7- a@ y1,00.G©r1 AGREEMENT:The undersigned applicant agrees to comply with all provisions of the Everett Municipal Code Title 11�� City of Everett Official 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,as a condition precedent to receiving service that the utilities division shall have , 1 �o ,co the right at any time,without notice,to shut off or turn on the water supply for repairs,construction,and `y�+ nonpayment of charges or for any other reasonable cause.lam the owner,or lam authorized by the owner of this property to perform the work for whi • -• cation is made,and t comply with the State Contractors Law 18.27 PERMIT# 1_, %-2.(6' 122 u \?)02;,-) 0 O ' Authorized A>' ignature Date (Revised 10/12/2015)