7305 E HEATHER WAY 2019-06-03 - Laserfiche WebLink

iiMircE-i / SEWER UTILITY 1TPUCATION CITY OF EVERETT PERMIT VICES `�� 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 SITE INFORMATIONI PROJECT ADDRESS: j . %— f ' f IF APPLICABLE: 0 OUTSIDE CITY LIMITS 0 BUILDING AREA SF 0 LOT# BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑DULEX ❑MULTI-FAMILY#OF UNITS: ❑COMMERCIAL El 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 ❑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: 0 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: /L12 —1(Y\t h,J\P_J nAharIe\ TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET 03 2 i2- Sit- CfIY ) � STATE L4 ' ZIP'[a( C41-'0OWNER PHONE: i - �11Q,i f OWNER EMAIL: . `'\yNe.. \ 1 \ E T-1 CONTRACTOR NAME: A- -pct/ 0Inc CONTRACTOR ADDRESS: STREET 0�• (l 0 3 fa/IC;U ill/E.- - ,n CITY ;wee STA v v/ ZIP` 4 I, , af CONTRACTOR PHONE: 4 —61(Z31CONTRACTOR EMAIL: fm- v-04 ( tic—, C1) ) 4 CONTRACTOR LIC.#(REQUIRED): V < I✓ CITY OF EVERETT BUSINESS LI (REQUIRED):,Q SYR PRIMARY CONTACT: ❑OWNER l� ACTOR 0 OTHEReci Please Specify) p fir) CONTA AME: CONTACT PHONE: (AI �/ 80` ��U Ch, c„ �� CONTACT EMAIL: � p (/ In11� �j11 tJ ��/ _ / my 917 AGREEMENT:The undersigned applicant agrees to comply with all provisions of the Everett Municipal Code Title Cityof Everett OfficP�se Only pP PY p .Y 14 Water and Sewer or such oth- #les and regulations now existing or which may be established from time to FEE time.The applicant further a. -es,as ondition precedent to receiving service that the utilities division shall have the right at any time,witho notice,to shu •ff or turn on the water supply for repairs,construction,and O ----- nonpayment of charges or or. oth-r rea o•.ble cause.lam the owner,or 1 am authorized by the owner of this property to perform the w. k'. ‘ appli::ti. is made,and 1 comply with the State Contractors Law 8,27 PERMIT# ✓ RCW and 296.200A WA 1 *2 u k cy O S — y+�.S I ' V\,06V' ' I" S Owner/Authorized Agent `'e nature Date (Revised 10/12/2015)