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WATER / SEWER UTILITY APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />EVERETT SUBMITTAL INSTRUCTIONS: Drop off herd Copy paper application& plans 10 32W Coda Street 2M Floor intake Drop Box. <br />CONTACT INFORMATION:(P) 425.257.08101(E) PemlltSm"ina @everettWageV I(W) everalMa.gov/permlta <br />PROJECT SITE INFORMATION <br />11 <br />PROJECTADDRESS: Sc / SI Sr ST SVs% <br />IF APPLICABLE: ❑ OUTSIDE CRY LIMITS ❑BUILDING AREA /4OO SF ❑LOT# <br />BUILDING TYPE: II ❑TOWNHOUSE ❑DUPLEX ❑AOU ❑MULTWMILY40FVNITS:_ 000MMERCL4 ❑ACCESSORY <br />CHANGE OF USE'! NO ❑YES, FROM TO <br />UTILITY APPLICATION INFORMATION <br />SEWER (check all that apply) <br />WATER (check all that apply) <br />❑ SIDE SEWER REPAIR <br />❑SIDE SEW ER ALTERATION <br />YIJJNEW SIDE SEWER INSTALLATION <br />❑ INSTALL BACMNATER VALVE(outsie the Wilding) <br />❑ SIDE SEWER CAP -OFF <br />❑ SIDE SEWER RECONNECTION <br />❑ BACKFLOW PREVENTION (Outside) -Specify device type below: <br />❑RPBA(dom.) ❑DCVA(dom.) ❑DCVARr-) ❑DCDA(firs) <br />❑ WATER LINE BEHIND METER(ropelr or alteration) <br />❑ NEW WATER SERVICE INSTALLATION <br />Spea fy installation type below: <br />❑ NEW COMPLETE SERVICE <br />❑METER ONLY <br />Speully waferservlre type"zo below: <br />❑DOMESTIC: ❑314" ❑1" ❑2" ❑Other. <br />IRRIGATION: ❑314° ❑1" ❑2 ❑Other: <br />❑FIRE: ❑r ❑2" ❑4" ❑6" ❑0" ❑OIMr <br />❑ DOMESTICIFIRE COMBO: ❑1" ❑2' ❑OUter <br />MULTIPLE DOMESTIC WATER SERVICES REQUEST <br />❑ I AM DECLINING MULTIPLE DOMESTIC WATER SERVICES FOR <br />MY MULTI -FAMILY DEVELOPMENT UNDER SINGLE OWNERSHIP. <br />❑ I AM OPTING TO INSTALL MULTIPLE DOMESTIC WATER <br />SERVICES FOR MY MULTI -FAMILY DEVELOPMENT UNDER <br />SINGLE OWNERSHIP. FILL OUT REVERSE SIDE OF THIS FORM. <br />CONTACT INFORMATION <br />OWNER NAME: KATENANT BUSINESS NAME (if Commercial: <br />OWNER MAILING ADDRESS: S% 'SW <br />,�,Z. �y5/ <br />MATE PV-4— KZD <br />OWNERPHONE: OWNEREMAIL':m <br />CONTRACTOR NAME: SE'W�7q- QB% LT7//e�S <br />CONTRACTOR ADDRESS: STREETZ/'S /s fµ s7l?�'% <br />- <br />S7JU"VAd7 ,T re W� g21 d <br />/p <br />CONTRACTORPHONE: v�> I2,3fSSCONTRACTOR EMAIL: S-15 T6/L. J ItL� <br />CONTRACTORLIC.11REOUIREO <br />- YVR <br />HOOOA1 <br />E <br />CRYOF EVERETT BUSINESS LIC. N(REWIRED): SIi'(A% <br />PRIMARYCOITACT: 016WNER ❑CONTRACTOR ❑OTHER(Please Specfy) <br />CONTACT NAME: 1 <br />CONTACT PHONE: a�']�< 23 C/9 S <br />CONTACT EMAIL: P /l/t'-I . C <br />AGREEMENT.IInun6wa¢n•dapp.4cartapew[(•wryly wilhappmwvana aft ftwou MunklpelCMe The 14 WaM1raMSaxwwnMolMr MGaeM •emw <br />exlSMgwwlu[h mry6eeYaWiahNlmm(mpbino..TheegJkenllwllreragnas,"amMlronpmuEonlbmeN4yxrvke MM Me MoksaA ur NmYhace lM not <br />aayllm5 whomembe, Mahal •Nw(wnm(Ire w•NraupTAybmpalrs, mnahac M" aMnwma)meMMahwgMwlwenY Mlea reaswuda •wro.l am lhs•wrer, or I" <br />eullwnmtlhy Ne•wiur Mlhkp'•pMybpMwmlM uaTMwhkh eppN[elbnk m•tle, sM l wmay" llre&I COMxbrs Lew I89RCRI MM AMAWAG. <br />�j /1 IEI Ca MEvemLOMMVMOW <br />3 2� PERMITN'3O�-ool <br />Own•dAmx dAg• anat� Data (ReUwsei fl4M21) <br />