2927 ROCKEFELLER AVE 2019-08-08 - Laserfiche WebLink

W ER I SEWER UTILITY c- UUC< <l TIO ,witiietollibiz_02,....a,. _,_;_ 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.govipermits PROJECT SITE INFORMATION; __.. PROJECT ADDRESS: tQl:i7 Ce JJer /0/"€-- IF 0 "€-- IF APPLICABLE: 0 OUTSIDE CITY LIMITS 0 BUILDING AREA SF 0 LOT# BUILDING TYPE: ❑SFR-DETACHED ❑SFR ATTACHED ❑DULEX ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL ❑INDUSTRIAL CHANGE OF USE? 0 NO 0 YES, FROM TO UTILITY APPLICATION INFORMATION , SEWER(check all that apply) WATER(check all that apply) ❑SIDE SEWER REPAIR )(NE WATER SERVICE INSTALLATION ❑ SIDE SEWER ALTERATION ICO ,'LETE SERVICE 0 METER ON SIDE SEWER INSTALLATION SERVICE/ ER USE: ❑ INSTALL BACKWATER VALVE(outside the building) 0 SFR N .-Pr ❑ SIDE SEWER CAP-OFF 0 MULTI-FAMILY-# b UNIT'. SIDE SEWER RECONNECTION j d(0, o,'L-✓ 0 COMMERCIAL MULTIPLE DOMESTIC WATER SERVICES REQUEST WATER SERVICE TYP SIZE: (c le desired size) ❑ I AM DECLINING MULTIPLE DOMESTIC WATER SERVICES FOR • DOMESTIC: 't 3/4" 2", OTHER: MY MULTI-FAMILY DEVELOPMENT UNDER SINGLE OWNERSHIP. 0 IRRIGATI e : . 3/4", 1", ", OTHER: ❑.I AM OPTING TO INSTALL MULTIPLE DOMESTIC WATER 0 FIR . 1", 2", 4", 6", 8", sTHER: SERVICES FOR MY MULTI-FAMILY DEVELOPMENT UNDER 0 iOMESTIC/FIRE COMBO: 1", 2", OTH SINGLE OWNERSHIP. FILL OUT REVERSE SIDE OF THIS FORM. CONTACT INFORMATION OWNER NAME:54'l ()14- PL)12Y dTENANT NAME(If Commercial): OWNER MAILING ADDRESS: s4�kEEr il. At'`e__- CITY- `P��'P �y STA ak ZIF &"- OWNER PHON ��//)) . . (.4 -�0 p OWNER EMAIL: 1)tL n 0 a .,, ...c r .. w CONTRACTOR NAME: 14.,( 1OAier s //J CONTRACTOR ADDRESS: STREETti c o. S I s ai� ,e CITYSe, STATEA ZIP qU Otryc ZSZ) �j 1 CONTRACTOR PHONE: �s� L�J JOE CONTRACTOR EMAIL: �.�/'J(�7l� CONTRACTOR LIC.#(REQUIRED) 6O - bb CITY OF EVERETT BUSINESSLIC.#(REQUI :0 - PRIMARY CONTACT: 0 OWNER ycONTRACTOR 0 OTHER(Please Specify) CO CT NAME: CONTACT PHONE: Z -SSD.[ —,_? /Ga<e'iIU6'4 CONTACT EMAIL:eAn!'I/eA(DG'�S AGREEMENT:The undersigned applicant agrees to comply with all provisions of the Everett Municipal Code Title Gverett 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 • ®° the right at any time,without notice,to shut off or turn on the water supply for repairs,construction,and kg,O �-- •. •ayme • - arges or for any• - easonable cause.I am the o ner,or I am authorized by the owner of this prop y t.perfo tte ork for 0 -•'lication is made,and I comp a with the St e Contractors Law 18.27 PERMIT# Ili1 �� -ata -'I horized Agent Signature late (Revised 90/92/2095)