1033 OAKES AVE 2019-08-07 - Laserfiche WebLink

WATER / SEWER UTILITY APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 I FAX 425-257-8857 1 (E)everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: f!)33 LJ Cc V.Lb AW- t\9-� ficK e \./0 r"\._ IF APPLICABLE: 0 OUTSIDE CITY LIMITS 0 BUILDING AREA SF 0 LOT# BUILDING TYPE: XISFR ❑TOWNHOUSE ❑DUPLEX ❑ADU ❑MULTI-FAMILY-#OF UNITS: OCOMMERCIAL ❑ACCESSORY, CHANGE OF USE? 0 NO 0 YES, FROM TO UTILITY APPLICATION INFORMATION SEWER(check all that apply) WATER(check all that apply) 7(1 SIDE 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 0 COMMERCIAL MULTIPLE DOMESTIC WATER SERVICES REQUEST WATER SERVICE TYPE/SIZE:(provide calcs to support size choice) ❑I AM DECLINING MULTIPLE DOMESTIC WATER SERVICES FOR 0 DOMESTIC: 03/4" 01" 02" ❑Other: MY MULTI-FAMILY DEVELOPMENT UNDER SINGLE OWNERSHIP. 0 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 0 DOMESTIC/FIRE COMBO: ❑i" 02" ❑Other: SINGLE OWNERSHIP.FILL OUT REVERSE SIDE OF THIS FORM. 0 BACKFLOW PREVENTION(Outside): ❑RPBA ❑DCDA ❑DCVA CONTACT INFORMATION OWNER NAME: ��.•.i A kit T 1kLp S`ic TENANT BUSINESS NAME(If Commercial): OWNER MAILING ADDRESS: STREET l b 3 � D C OLZ As-‘,-)--"L CITY �\)•{5 , A. STATE w Ck. ZIP q$�V C OWNER PHONE: aV rrb p `tt` l33L OWNER EMAIL: �S`y . ken g- ��)V1�LCfL L Co' CONTRACTOR NAME: \ - . ' �� ( lt9fN CONTRACTOR ADDRESS: STREET { 0 ), \--\ Q\'\ \Ei) r -\-, ��{/ CITY TN STATE Q ZIP (1( 0 i CONTRACTOR PHONE: 2O6 q03- B,5 O CONTRACTOR EMAIL: SkY••�r\-sem. Lp (.D ��1 YNA rc i l I .col"' CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): PRIMARY CONTACT: ]OWNER 0 CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: ff CONTACT PHONE: 2O(L,, q LI -1 -5(4 q--99`.,I`&-e.VN.. CONTACT EMAIL: \h 5,-),,, a k�-\(/(�- (t)I •(U'L-- AGREEMENT:The undersignedapplicant.agrees to comply with all provisions of the Everett Municipal o a Nike 14 Water and Sewer or such other rules and regulations now existing or whi -may be e-tabl{shed from tit e'Io time. .=appli_ rther agrees,as a condition precedent to receiving service that the utilities division shall have the right at any time,without otice, ..sfiut off or tur "n. .. er Supp .r ret-' construction,and nonpayment of charges or for any other reasonable cause.I am the owner,or I am authorized by the o -,of this propert, d erfovs4.a wo• . , 'h appli.ation is made,and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only i / / /// ' PERMIT# 1,. ''' il / '.,/ -)Y1 7 U `103- 03 (0 Own /Au o , ge i t : • = ' Date (Revised 10/1212018) Y