2002 OAKES AVE 2019-06-11 - Laserfiche WebLink

Feb 14 19,01:06 Holstad's PLUMBING INC. 3605889814 p.1 WATER 1 SEWER UTILITY APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 J FAX 425-257-8857 I (E) everetteps@everettwa.gov J www.everettwa.govlpermits PROJECT SITE INFORMATION PROJECT ADDRESS: a2p 0 OZ 00{-E eS tr , IF APPLICABLE: 0 OUTSIDE CITY LIMITS ID BUILDING AREA SF 0 LOT# BUILDING TYPE: OFR-DETACHED ❑SFR-ATTACHED ❑DULEX ❑MULTI-FAMILY-#OF UNITS: DCOMMERCIAL QINDUSTRIAL CHANGE OF USE? jINIO 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 0 SIDE SEWER ALTERATION ❑COMPLETE SERVICE 0 METER ONLY ❑NEW SIDE SEWER INSTALLATION SERVICE/METER USE: ❑INSTALL BACKWATER VALVE(outside the building) ❑SFR O SIDE SEWER CAP-OFF CI MULTI-FAPr1ILY-##OF UNITS: ❑ SIDE SEWER RECONNECTION 0 COMMERCIAL MULTIPLE DOMESTIC WATER SERVICES REQUEST WATER SERVICE TYPE/SIZE: (circle desired size) © 1 AM DECLINING MULTIPLE DOMESTIC WATER SERVICES FOR CI DOMESTIC: 3/4", 1", 2", OTHER: MY MULTI-FAMILY DEVELOPMENT UNDER SINGLE OWNERSHIP, 0 IRRIGATION: 3/4", 1", 2", OTHER: ❑ 1 AM OPTING TO INSTALL MULTIPLE DOMESTIC WATER ❑ FIRE: 1", 2", 4", 6", 8", OTHER: SERVICES FOR MY MULTI-FAMILY DEVELOPMENT UNDER El DOMESTIC/FIRE COMBO: 1", 2", OTHER: SINGLE OWNERSHIP.FILL OUT REVERSE SIDE OF THIS FORM. . . // CONTACT iINFORMATIoN _ •OWNER NAME: L t S o- P k o ( f es TENANT NAME(If Commercial): OWNER MAILING ADDRESS: sTREET a7D0 c.1 00-...t. " Ce t)C. � CrY t`, Vig STATE (A )7A • ZIP<15? !N1 OWNER PHONE: 707 �(off ?,44 s2D OWNER EMAIL: C CONTRACTOR NAME: /4 /Lv.3 l PUP., �....._ �..._. _..,. . ...... CONTRACTOR ADDRESS: STREET -Pig .P- x - 6-91 CITY' e t{(. 4 STATE 1....941 t ZIP 4 g 4pV e CONTRACTOR PHONE:/0:5 Q 59 et/5/ CONTRACTOR EMAIL:A Sri4pLf is r•A ,'n rltt Q r,c,,yt{. CONTRACTOR LIG.#(REQUIRED);eklm 5 '`p ag 1419 CITY OF EVERETT BUSINESS LIC.#t REQUIRED o w,Q PRIMARY CONTACT: ❑OWNER .ErcONTRAOTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: j j $ a?7' 4a� —re I( y' t4CONTACT EMAIL: AGREEMENT:The q.t3ersigned applicant agrees to comply with ail provisions of the Everett Municipal Code Title City of Evereft Official Use Only 14 Water and Sewer or such other rules and regulations now existing cr which may be established from time to time.The applicant further agrees,as a condition precedent to receiving service that the utilities division shall have FEE , 4, co the right at any time,without notice,to shut offorturn on the water supply for repairs,construction,and nonpayment of charges or for any other reasonable cause.l am the owner,or l em authorized by the owner of this 0 ------ property to perform the work for which application is made,and 1 comply with the State Contractors Law 18.27 PERMI RCN and 29 .200A WoAC. fyu / tri't t u lot0�� I Owner/Authorized�� rY"` kK 'W. Q./,ts _I L Agent Sloll- u e g Date (Revised 70/9212010)