7325 E HEATHER WAY 2019-06-03 - Laserfiche WebLink

0T / SEWER UTILITY PLUcATIO CITY OF EVERETT PERMIT SL-c ICES 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 INFORMATION PROJECT ADDRESS: 1--)--2-,0 5 6 ` J 1 l:l C c (/ U 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? 0 NO 0 YES, FROM TO UTILITY APPLICATION INFORMATION SEWER(check all that apply) WATER(check all that apply) Sl�l DE 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 0 SIDE SEWER CAP-OFF 0 MULTI-FAMILY-#OF UNITS: 0 SIDE SEWER RECONNECTION ❑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: bf\/ W takik a... TENANT NAME(If Commercial): ' / D� OWNER MAILING ADDRESS: STREET ,e , J �t*L&e.A/ Lk) n% crrY i•v s ^ � STATE ZIP L iio 3 OWNER PHONE: .-D6 --3'%, CTS OWNER EMAIL: CONTRACTOR NAME: - p/1,414 Lt vL. ( ` c_ 31Q'1zJ m l vi."t/I , CONTRACTOR ADDRESS: SWEET ‘26/g Vi 5-1714/4.p& M `- an, '( V-e � STATE ZIP 7 7 0-6 CONTRACTOR PHONE: 4''2 S u�r 7"012-.) CONTRACTOR EMAIL: �� pjv M [!2[x;1 //L /I.i-I�D ,,,..,/ CONTRACTOR LIC.#(REQUIRED): POIVOM 0 . CITY OF EVERETT BUSINESS LIC REQUIRED):e S- p PRIMARY CONTACT: 0 OWNER ONTRACTOR 0 OTHER(Please Specify) CO ACT NAME: CONTACT PHONE: feu 9r©�2 3� /-7 /� ,/�.�r UIZ�1S ��t CONTACT EMAIL: Il l GI4/oivi /1 e s_s, '7'6Cl�i i! AGREEMENT:The undersigned applicant agrees to comply with all provisions of the Everett Municipal Code Title LJity of Everett Official Use Only � 14 Water and Sewer or such of . -es and regulations now existing or which may be established from time to FEE time.The applicant further ag—es,as-condition precedent to receiving service that the utilities division shall have D __ the right at any time,withou i.otice,to s t off or turn on the water supply for repairs,construction,and nonpayment of charges or . -, .her re..onable cause.lam the owner,or I am authorized by the owner of this property to perform the wo . ,`I' a,,lic.tion is made,and I comply with the State Contractors Law 18.27 PERMIT# T RCW and 296.200A WAC. " Owner/Authorized Agent ,` :ture D (Revised 10/12/2015)