3631 WETMORE AVE 2022-05-18 - Laserfiche WebLink

kii!ii .-.' TER I SEWER UTILITY APPLICATION viiiiiii 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 SITE?INFORMATION PROJECT ADDRESS: Vio)J I Wt vV%'ed IF APPLICABLE; 0 OUTSIDE CITY LIMITS 0 BUILDING AREA SF 0 LOT# BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑DULEX ❑MULTI-FAMILY-#OFUNITS: ❑COMMERCIAL ❑INDUSTRIAL CHANGE OF USE? NO ❑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: lit INSTALL BACKWATER VALVE(outside the building) 0 SFR 0 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: O 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: s'eubiAcktA,5 ' "t ` I..) TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET CITY STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: �' P p • CONTRACTOR ADDRESS: STREET I �� 1� iL CIN STATE LSA . ZIP ', CONTRACTOR PHONE:114.2A $"'O1 CO TRACTOR EMAIL: \ - l M 1 1 O a low CONTRACTOR LIC.#(REQUIRED): L t CITY OF EVERETT BUSINY LIC.#(REQUIRED) ® i �.:..._..N. PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: . CONTACT PHONE: (../14621S. 612,b-(16121 a Ni � \ CONTACT EMAIL: A / I ( mvtien ( lc -7®a 1 seNA AGREEMENT..The PP undersigned applicant agrees to comply with all provisions of the Everett Municipal I.de Title City of Everitt Official Use Only 9 14 Water and Sewer or such other rules and regulations now existing or which may be established from time to FEE time. The applicant further agrees, . a con.,'• precedent to receiving service that the utilities division shall have the right at any ' e,w' • t notice to shut off o turn on the water supply for repairs,construction,and W, ✓ nonpayment.f ch:r.-s or or an otherreasona le cause.lam the owner,or I am authorized by the owner of this property top- or he wo hich applicatio is made,and I comply with the State Contractors LN/18.27 PERMIT# RCW and 29;200, WAC �{ '�, U ' IOu\l �q ul �C1-OO C3wner/Authoriz•ei,'gent Sig1ature Date (Revised 10/12/2015)