222 48TH ST SW 2021-12-20 - Laserfiche WebLink

WATER / SEWER UTILITY APPLICATION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 WASH INGTON (P) 425-257-8810 1 FAX 426-257-8857 1 (E) everetteps@everettwa.gov I www.everattwa.gov/permits UTILITY APPLICATION INFORMATION SEWER (check all that apply) WATER (check all that apply) ❑✓ SIDE SEWER REPAIR Cl NEW WATER SERVICE INSTALLATION ❑ SIDE SEWER ALTERATION ❑ COMPLETE SERVICE ❑ METER ONLY ❑ NEW SIDE SEWER INSTALLATION SERVICE / METER USE: ❑ INSTALL BACKWATER VALVE (outside the building) ❑ SFR ❑ SIDE SEWER CAP -OFF ❑ MULTI -FAMILY - # OF UNITS: - - -: ❑ SIDE SEWER RECONNECTION ❑ COMMERCIAL MULTIPLE DOMESTIC WATER SERVICES REQUEST WATER SERVICE TYPE 1 SIZE: (provide calcs to support size choice) ❑ I AM DECLINING MULTIPLE DOMESTIC WATER SERVICES FOR ❑ DOMESTIC: ❑3/4" ❑1" ❑2" ❑Other : _ _ MY MULTI -FAMILY DEVELOPMENT UNDER SINGLE OWNERSHIP. ❑ IRRIGATION: 03/4" 01" ❑2" ❑Other : ❑ 1 AM OPTING TO INSTALL MULTIPLE DOMESTIC WATER ❑ FIRE: 01" 02" ❑4" ❑6" ❑8" ❑Other .: SERVICES FOR MY MULTI -FAMILY DEVELOPMENT UNDER ❑DOMESTIC/FIRE COMBO: ❑1" 02" ❑Other : SINGLE OWNERSHIP. FILL OUT REVERSE SIDE OF THIS FORM. ❑ BACKFLOW PREVENTION (Outside): ❑RPBA ❑DCDA _❑DCVA AUK—=MtN f; the undersigned applicant agrees to comply with all provisions of the Everett Municfpai Code Me 14 Water and Sewer or such other rides and regulations now existing or which may be established from time to time. The applicant further agrees, as a condition precedent to receiving service that the utilitias division shalt have the right at any time, without notice, to shut off or tum on the water supply for repairs, construction, and nonpayment of charges or for any other reasonable cause. I am the owner, or 1 am authorized by the owner of this property to perform the work for which application Is made, and I comply with the State Contractors Law 18.27 RCW and 296, 200A WAC. Crdy: of Everett Official, Use Only PERMIT # . ,. (Revised 1011212018)