705 CABOT RD 2019-05-29 - Laserfiche WebLink

"op . ATE • I SE E- UTILITY ,kPPLICATION IO 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 Y ' PROJECTkSITE INFORMATION0 PROJECT ADDRESS: 'IO U Cci y o+ rv[it • . IF APPLICABLE: 0 OUTSIDE CITY LIMITS 0 BUILDING AREA SF 0 LOT# BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑DULEX ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL DINDUSTRIAL CHANGE OF USE? ❑NO ❑YES, FROM TO UTILITY APPLICATION INFORMATION v ... 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: ❑ 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: TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET CITY STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: f g& /2_1(//////5o66:,,, CONTRACTOR ADDRESS: STREET ..7.--2".2, 97 A-1/V-- A) cffr 0-4144_ . "A 5 �/ f�, STATEN't ZIP ' 0 �i CONTRACTOR EMAIL: /VII�-xrH LkIA46A CONTRACTOR PHONE: ��S � �'��%� CONTRACTOR LIC.#(REQUIRED) V-IZ-.pG%70/t` / CITY OF EVERETT BUSINESS LIC #(REQUIRED): , _s rn PRIMARY CONTACT: 0 OWNER WONTRACTOR ❑ OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: ...c:06--79/4.--7C/6 ��A,vO )‘(9r/tilCONTACT EMAIL: ..,4 'v AGREEMENT:The undersigned applicant agrees to comply with all provisions of the Everett Municipal Code Title City of Everett Official Use Only 14 Water and Sewe or such other rules and regulations now existing or which maybe established from time to FEE 0 /1 time.The applican rther agrees,as a condition precedent to receiving service that the utilities division shall have W J o the right at any ti without notice,to shut off or tum on the water supply for repairs construction,and Lo nonpayment of c -rges or for any other reasonable cause.tam the owner,or I am authorized by the owner of this property to perfor the -ork for which application is made,and I comply with the State Contractors Law 18.27 PERMIT `R/C'Wand 296.29t'AW . I 3 ✓ + 9..- U ktbol—o3i0 Owner/Aut •r -% •,-nt Si•nature Date (Revised 10/12/2015) '