2333 SEAWAY BLVD EVCC 2019-07-08

WIRER I SEWER UTILITY A LICATION ,,, CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 1 FAX 425-257-8857 1 (E)everetteps@everettwa.gov 1 www.everettwa.gov/permits '° PROJECT S1TE INFORMATION A PROJECT ADDRESS: 7, ?j' . '' (mac I(,7 d 64.4 / tdif- IF APPLICABLE: 0 OUTSIDE CITY LIMITS 0 BUILDING AREA SF 0 LOT# BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑DULEX ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL DINDUSTRIAL CHANGE OF USE? 0 NO 0 YES, FROM TO ', UTILITYAPPLICATION;INFORMATION SEWER(check all that apply) WATER(check all that apply) ❑SIDE SEWER REPAIR 'NEW WATER SERVICE INSTALLATION ❑SIDE SEWER ALTERATION O COMPLETE SERVICE 0 METER ONLY ❑NEW SIDE SEWER INSTALLATION SERVICE/METER USE: pD&L(k aft❑INSTALL BACKWATER VALVE(outside the building) 0 SFR �W a$�� ❑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. jRRIGATION: 3/4", • 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: go 4 of C TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET /2 ®C'?O / toG�'Q, 61 RS- -1,t-(94,-..e,4 )STATE / ZIP . 2 7( OWNER PHONE: �,��> -Ij RO " clti i%V3` OWNER EMAIL: p�tiot tiC�- & -e i^Le c.CI. , C C7 ct CONTRACTOR NAME: CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT� BUSINESS LIC.#(REQUIRED): M' PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR OTHER(Please Specify) 1-(x I 'T (0e,'v1 � CONTACT NAME: CONTACT PHONE: /r��s— 3!g 5. ('t (� `Pcd-r'C R '6v) ,,\_ CONTACT EMAIL: p, , 9,e„,,,...„,„ „ „ft, AGREEMENT:The undersigned applicant agrees to comply with all provisions of the Everett Municipal Code Title City of Everett Official Use Only 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,as a condition precedent to receiving service that the utilities division shall have -361the right at any time,without notice,to shut off or turn on the w- : supply for repairs,construction,and nonpayment of charges-r for a.y other reasonable cause. . e owner,or I am authorized by the owner of this prope . .erform th/ork Iwhich plication is ma.• I comply withthe State Contra rs Law 18.27 PERMIT# Wand rif "C. 11 -7 /`' U / (f - er Ow -r/Authorized Agent Signature Date (Revised 10/12/2015)