3924 FEDERAL AVE 2019-06-24 - Laserfiche WebLink

�� WATER / SEWER UTILITY APPLICATION A0►✓.- ...- CITY OF EVERETT PERMIT SERVICES Iii' 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: 3 "1 7.2-1- 't-e.1-c c ,\ -WE._. Err--c U4 `W I Cl . ; - ' Z.61 IF APPLICABLE: ❑OUTSIDE CITY LIMITS ❑ BUILDING AREA SF El LOT# BUILDING TYPE: ❑SFR ❑TOWNHOUSE ODUPLEX ❑ADU ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL ❑ACCESSORY CHANGE OF USE? ❑NO ❑YES, FROM TO UTILITY APPLICATION-INFORMATION SEWER(check all that apply) WATER(check all that apply) KSIDE 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 ❑COMMERCIAL MULTIPLE DOMESTIC WATER SERVICES REQUEST WATER SERVICE TYPE/SIZE:(provide calcs to support size choice) ❑I AM DECLINING MULTIPLE DOMESTIC WATER SERVICES FOR ❑DOMESTIC: 03/4" 01" 02" ❑Other: MY MULTI-FAMILY DEVELOPMENT UNDER SINGLE OWNERSHIP. ❑IRRIGATION: 03/4" 01" 02" ❑Other: ❑I AM OPTING TO INSTALL MULTIPLE DOMESTIC WATER 0 FIRE: 01" 02" 04" 06" 08" ❑Other: SERVICES FOR MY MULTI-FAMILY DEVELOPMENT UNDER ❑DOMESTIC/FIRE COMBO: 01" 02" ❑Other: SINGLE OWNERSHIP.FILL OUT REVERSE SIDE OF THIS FORM. El BACKFLOW PREVENTION(Outside): ❑RPBA ❑DCDA DDCVA CONTACT INFORMATION OWNER NAME: D cA.S i k. \ Cv-E<- TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET 3 ck 2..L1- ft.Lc` MI E CITY f,,,j L C'e- STATE WAC ZIP 9 q 2_o 1 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: 3c1L a C.—e..n.�q A.4 LCA L CONTRACTOR ADDRESS: STREET t(t1 NY 21 A Sk. CITY S C A. `STATE A A ZIP CI 6I 6 3 t . CONTRACTOR PHONE: (2 S Z ` 3.S G O 1CONTRACTOR EMAIL: e.vq t-o e oke t./1 t,,,.n .G o CONTRACTOR LIC.#(REQUIRED): 3'A;f 6 0 LI— 13 3 ?\ CITY OF EVERETT BUSINESS LIC.#(RE IRE . f' .)).. PRIMARY CONTACT: ❑OWNER 18I CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: (71 ) 6O(7 — '2.4S tk‘Ir-LN Gq C ZC\ CONTACT EMAIL: Mr1; 4 G�� ,e. L„Lavd, A—^-,�• . Le, AGREEMENT.'The undersigned applicant agrees to comply with all provisions of the Everett Municipal Code Title 14 Water and Sewer or such other nil s ardi regulations nes existing or which maybe established from time to time.The applicant further agrees,as a condition precedent to receiving service that the utilities division shall have the right at any time,without••tice,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 lam authorized by,-e. ner of this property to perforin the work for which application is made,and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. 'J PERMIT City of Everett Official Use Only # r!►,= 1z - el- I46 U « 2 - b� Owner/I Agent Signature Date (Revised 10/12/2018) / �