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WATER / SEWER UTILITY APPLICATION <br />LCITY OF EVEflETi PERMIT SERVICES <br />EVERETT MI.YRTAL INSTRUCTSMS NW OR hPd(NVr'FJap calm A pvv I, Ow CvYI Sam,]M ilw•i. i.. <br />F dF10 I F i Pvrnn Sn1, e,i m,PITWAm DO wnOIm TIP^•"^ <br />WkIkLNGTON <br />PROJECT SITE INFORMATION <br />PROJECT ADDRESS: Z I jL y_ L , <br />IF APP1GJlE: ❑RSIDE CITY UNITS❑BWLOINGAREA SF CLOT A-- -- <br />IX <br />BUILDINGTYPE OTOWNTROUSE DDPTE% CAN OMULTIFMIILYJCFUNRS'_ OCCMMERU& OKCESSMY <br />CHANGEOFUSEI SAND DYES. FROM_. _ TO -- <br />vnuTT Ar►IJICATION INFORMATION <br />SEWER weak all that apply) <br />WATER ItlIa[L all IINI apAYI <br />17310E SEWER REPAIR <br />❑ BA[NFLOW PREVENTION IOuekalSPIC"YbrM"Nal <br />❑ SIDE SEWER ALTEMTION <br />ORFBAIO+III DOCVA I4 ^1 DDLVA I+II DOCDA IMq <br />❑ WATER LANE BEHIND METER pe%n IN MMENNI <br />❑ NEW SIDE SEWERINSTA1AFON <br />❑ INSTALL BACIIWATER VALVE gW$II PM WMMI <br />O NEW WATER SERVICE INSTALLATION <br />❑ SIDE SEWER CAP-OFF� <br />NUWM4mBRMY <br />❑ SIDE SEWER RECONNECTION <br />O NEW CDAPETE SERVICE <br />❑ METER ONLY <br />SPY"YYM1b'AVF'k•DLY E+NYEW'f <br />MULTIPLE DOMESTIC WATER SERVICES REQUEST <br />❑ I AM DECLINING MULTIPLE DOMESTIC WATER SERVICES FOR <br />MY MULTI FAMILY DEVELOPMENT UNDER BINDLE OWNERSHIP. <br />0DOMESTIC OYa' Ot' OT DCNNM <br />D I AM OPTING TO INSTALL MOLPPIE DOMESTIC WATER <br />❑IRRIGAPON' DYP Of DY DOVM: <br />SERVICES FOP MY MULTI FAMILY DEVELOPMENT UNDER <br />❑FIRE 01' D]' Ba' OW OW DDIM. <br />SINGLE OWNERSHIP. FILL WFREYEREE SIDE OF SMRM <br />❑ WMESTICJFIRE COMBO 01' Oi' OLMBI. <br />CONTACT IMPOIIYAIFION <br />OWNERNAME' M Pvnf,,AAA1j TEMM? BUSINESS NAME 0CMImvcIN: <br />OWNERMNLINGMM03: 31 cOtM air, <br />,. <br />. Uc11s"I� n V 6 <br />ERPIONE: 2S OS OWNEREMNL SN MPIJ 11T IiI CE <br />NTNACTOR X.UIE: _ �, Q IE— <br />ACTOR ADDRESS: mw S s N <br />c E wa 3 <br />CONTMCTORPHOME: ZOC LD <br />CONTRACTOR EMNL: PAi Cv O eApb NY•COM <br />ACTOROC.MREMXRE SACC (L437pvt,CM OF EVERETY BUNNES IrC. REWIRED-. <br />PCUMADYSCT: OOWNER CONTRACTOR DOTHERIPkPa SPs"rMl <br />DDMrILcr MAME',Zw OEYTCP— <br />CONTACT PHONE: 06 S O S <br />CANFACT EYNL: G [n M.P QN M <br />.cREEAEWF m.w.ro.AWm•aR�e�Pr..��Pe..o.o....._. _........_._,_ _._ <br />®pv MMnNbwmW pnvnow MANM119���munPmRe•eM9wbYbpvYeJYn piMpiPIY <br />qw. �/nAim. eYYolsunm M1ew'R6Yb•MY'a miwoUt vMvpP�vtltl�pYvbrybbn�YAYa,M1 IVIIM1M1�. vlvn <br />vlv0fhps�tlpF�PR� e[�v^p Mb W/i1WYp RnY. W Im,W plpdM1 li'tlme I� ILPM1CW NAEpIr MC <br />tl Ew�L LNBY Is <br />PE MIT/ <br />p it <br />OwYMIMMVL MMB^rR . PNNYMAa IOm}r <br />