5725 COLBY AVE 2019-05-29 - Laserfiche WebLink

004. , WATER / SEWER 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 PROJECT SI'T'E INF,OIRMATION -- , `.t: t PROJECT ADDRESS: S 7Z c Co a1/ 9 ?ZA3 IF APPLICABLE: 0 OUTSIDE CITY LIMITS 0 UILDING AREA SF 0 LOT# BUILDING TYPE: SFR-DETACHED ❑SFR-ATTACHED ❑DULEX ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL ❑INDUSTRIAL CHANGE OF USE? 0 NO 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 1 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 Cs ERCIAL MULTIPLE DOMESTIC WATER SERVICES REQUEST ! WATT R S "VICE TYPE/ : (circlecldesired siz- 0 IAM RECLI ING MULTIPLE 50 •STIC WATER SERVICES FOR P 'OM'ES C: el 1", 2", 0 ER: MY ULTI-FA LY DEVE '.PMENT .NDER SIN E s NERSHIP. FA IRRIGATION: 3/4", ", 2", OTHE'. b 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: ,4f `'f,/ti S0 of, `/,J / TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET 57 2-s (-°0f/34v CITY62/11e6171". I STATE (/V.' a ZIP ?� �,,// OWNER EMAIL: 4 e-e.GUi}-S 1 6 In F3-/L , Lid"J OWNER PHONE: (/�D -G_GJ �.. .....,..n..k. Cl.• ..w. w .,....�. ..,. .�_w CONTRACTOR NAME: DIANW CONTRACTOR ADDRESS: STREET . CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED): x uNA „y � „��`ow'r CITY OF EVERETT BUSINESS LIC.#(REQUIRED): — PRIMARY CONTACT: X OWNER 0 CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: CONTACT EMAIL: 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 Sewer or such other rules and regulations now existing or which may be established from time to FEE 60 time.The applicant further agrees,as a condition precedent to receiving service that the utilities division shall have �, the right at any 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!am authorized by the owner of this property to perform the work for which application is made,and!comply with the State Contractors Law 18.27 PE IVT 069 0926RCW an. 96.200A WAC. 6 -41 1,(4. Owner • fhorized Agent Signafur Date (Revised 10/12/2015)