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WATER / SEWER UTILITY APPLICATION <br /> CITY OF FVER[TT PERMIT S[RVICES <br /> 3200 C[DAR STR[ET, EVERETT, WA 98201 <br /> (P) 425-257-8810 � f=AX 425-257-8857 � (E) everetteps@everettwa.gov � www everettwa govlpermits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADf7RE5S: {� <br /> IF APPUCABLE: ❑ OUTSIDE CIIY LIh11T5 ❑ BUILDING AREA SF O LOT r+ <br /> BUILDING TYPE: ❑SFR-UE iACHED SFR-ATTACHED ❑DULEX OMULTI-FAIc11LYm OF UNITS_ _ ❑COIdMLRCiAI ❑INDUSTP,IAL <br /> CHANGE OF USE? NO ❑ YES. FROM TO <br /> UTILITY APPLICATION INFORMATION <br /> SEWER (chec4 all that apply) WATER (check ali that apply) <br /> ❑ SIDF SEWER REPAIR ❑ NEW WATER SERVICL INSiALU1TION <br /> ❑ SIUE SEWFR ALT[RATION ❑ COMPLETE S[RVIC6 ❑ McTLR ONLV <br /> ❑ NE- SIDE SEVJER INSTALLATION ScRVICL I METER USE <br /> NST�LL �ACKWATER VALVE(outs�tle the bwltl�ng) ❑ SFR <br /> ❑ SIDF SEWER CAP-OFF ❑ MULTbFAh71LY-#OF UNITS _ <br /> ❑ SIDE SEWLf2 RECONNECTIO�; ❑ COMh1ERCIAL <br /> MULTIPLE DOMESTIC WATER SERVICES REOUEST WATER SERVICE 7YPE r SIZE (cucle desred sce) <br /> ❑ I A�d DECI.INING �dULTIPLE DOMESTIC WAT[R SERVICLS FOR ❑ DOMESTIC 3le", 1". 2", OTHER <br /> tdY MULT6f=AlJILY DEVELOPMENT UNDER SINGLE OWNERSHIP. ❑ �RRIGATION 3/4", 7". 2". OTHER� <br /> ❑ I AM OPTING TO WSTALL MULTIPLE DOMESTIC WATLR ❑ FlRE t". 2��. 4". 6", B", OTHER <br /> SFRVICES FOR�dY MULTI-FAMILY DEVELOPMENT UNDER ❑ DOMESTICl�IRE GOM60 1". T'. OTHER <br /> SINGLE OWNERSNIP FILL OUT REVERSE SIDE OF THIS FORM. <br /> �CONTACT INFORMATION <br /> OWNER NAME: �� TEIIANT NAME pf Commercial�� <br /> OWNER MAILING ADDRESS: saFci tQ <br /> c�rv si.�re z�� <br /> OWNER PHONE: ' — WNER EMAIL: <br /> CONTRACTOR NAME � � �� �lI`� <br /> CONTRACTOR A��RESS: srNiri - q^ <br /> arv <br /> L s�nn- :iv � (J <br /> CONTRACTOR PHONE: �Z r � CONTRACTOR EMAIL: GC /� <br /> CONTRACTOR LIC.77�RGauiRC:D�:S�T�Cj�7lc 3 L CITY OF EVERETT Bl1SINESS LIC.p0tE0UiREO1: O'I'� <br /> PRIMARY CONTACT: ❑OWNER ONl RACTOR ❑ OTHIcR(Please Spec�fy) <br /> CONTACT ME: CONTACT PNONE: � 3 <br /> � CONTACT EMAIL: - � <br /> AGNEEM14ENr ine untlers�9nee apP��can!apmes to comoy w,lh a�i pro��is�ons o��he Everelt N,unrc�pal Cotlr id�e Cdy o'Everetl OlGc�al Use Only <br /> 7�WaferuntlSeiverorsvclrofhe�N�esantlrC9ul,�ponsnoweershn9orwh¢hmayDees/ublis�edlmmhmeto PEt i�/'� <br /> hme Tne appM1canl turthe�agrees,as a contlitror�pmceaenl fo mcerving serv¢e Mal Ine uh��hes d�wsron snan nave /J(� ��� <br /> Ne nghl al any hme. wAho�f nohce, lo S�uf oN m him on I�e�valer supAN 1or repairs.conslrucfion, antl v�� <br /> nonpayment ol c�a o�lor any ol�er reaso�� e cause l am MC o�rner,or I am auMonreU�yl�e o�vne�o�I�is <br /> pmperty o� '��e� orA In� �.n�r^ o�wrro. maCe, and f compy�5rtn Ihe Stale Coa:iaclors Law iH 27 pERM1T!t <br /> RCl and296.10 L4'! / � /� / ,/�)� <br /> - �' / � / V <br /> [/ <br /> OwnedAu i enl5i atu ate (Revised 10/1717075) <br />