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WATER / SEWER UTILITY APPLICATION <br />CITY OF EVERETT PERMR SERVICES <br />EVERETT SUBMITTALINSTRUCTIONS: Drop off hard copy paper appllcaflon&plan to 3200 Cedar Skeet 2M Fluor Intake Drop Box. <br />WAaamaTOR CONTACT INFORMATION: (P)42-20L80f01(E)ParmltServleesOavereSWaVov I IW)everetkva.govryermiN <br />PROJECT SITE INFORMATION <br />OADU <br />APPLICATION <br />)$SIDE SEWER REPAIR <br />❑ SIDE SEWERALTERATION <br />❑ NEW SIDE SEWER INSTALLATION <br />❑ INSTALL BACKWATER VALVE outside the building) <br />❑ SIDE SEWER CAP -OFF <br />❑ 1 AM DECLINING MULTIPLE DOMESTIC WATER SERVICES FOR <br />MY MUL16FAMILY DEVELOPMENT UNDER SINGLE OWNERSHI{ <br />1 AM OPTING TO INSTALL MULTIPLE DOMESTIC WATER <br />SERVICES FOR MY MULTI -FAMILY DEVELOPMENT UNDER <br />SINGLEOWNERSHIP. FILL OUT REVERSE SIDE OF THIS FIRM <br />❑ BACKFLOW PREVENTION (Outside) - Speagydevka "balm. <br />ORPBA(dom.) ODCVA(dom.) ODCVA(Irr.) <br />ODCDA(Bre) <br />❑ WATER LINE BEHIND METER (repair or alteration) <br />❑ NEW WATER SERVICE INSTALLATION <br />Specify mandle#ork type bNow. <br />❑ NEW COMPLETE SERVICE <br />❑ METER ONLY <br />Specify wafer service type S size behave: <br />❑DOMESTIC: 0314" 131" OT <br />OOther: <br />El IRRIGATION OS14" Or O2' <br />OOtber: <br />❑FIRE: 01" 02' OP' 06" OB" <br />OOlher: <br />❑ DOMESTICIFIRE COMBO: 01" OT' <br />OOlher: <br />PRIMARYCONTACT: $OWNER ❑CONTRACTOR ❑ OTHER( Phrase Speclly) <br />CONTACT RAME: CON TACT PHONE: 2s le <br />CPIIa Cyal CONTACT EMA L: Sn GMIPI CO YVL C(L SJ. nP� <br />ollM EeM(MwMpSICab <br />TNnmEMglM OwnerallMSpMSrry (OpMarm Ms wk M-x1NCh epldTalmn enure, m01 Sc sMudh M3 Mals CmbeGM Lew 1&27RCWandak-2004t SAC <br />eye vare so On <br />�% <br />PERMIT# , � �a�3t f ��• a3 U 230t b <br />terRulnorlm AgentSLyrImpre Soup (Ravine WM2022l <br />