Laserfiche WebLink
WATER I SEWER UTILITY APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />EVERETT SUBMITTAL INSTRUCTIONS: Drop off bardwAypaperepplicallon&plan 10 32IM Cedar Slreal2nd Floor Intake Drop Box. <br />....... ,,.,,,, CONTACT INFORMATION: (P)425.25T.BS101(E) PemitServicos®evele .gov llW)everelhva.gov/petmlls <br />OF USE? ONO ❑YES, <br />®SIDE SEWER REPAIR <br />❑ SIDE SEWER ALTERATION <br />❑ NEW SIDE SEWER INSTALLATION <br />❑ INSTALL BACKWATER VALVE IrnMlde Me bullding) <br />❑ SIDE SEWER CAP -OFF <br />❑ I AM DECLINING MULTIPLE DOMESTIC WATER SERVICES FOR <br />MY MULTI -FAMILY DEVELOPMENT UNDER SINGLE OW NERSHII <br />❑ 1 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 />BACKFLOW PREVENTION (Outside)- Specify dmtice Type below: <br />ORPEA(dom.) ODCVA(dcm.) ODCVAdrr.) OUCDA(are) <br />WATER LINE BEHIND METER (repelror alteration) <br />Spealy Installation type below: <br />❑ NEW COMPLETE SERVICE <br />❑ METER ONLY <br />Specify waW service type & size below: <br />❑ DOMESTIC: OW4' 01- Or 00t e : <br />IRRIGATION: JW4" O1' OT' DOlber: <br />❑ FIRE: 1:11" 132" 04" OF OB" OOther: <br />(PRIMARYCONTACT: ❑OWNER ❑CONTRACTOR ❑ OTHER (Please Speuy) ) <br />14 <br />Oil NE7 OflMeI Dee OM <br />2)Yr� PERRMM <br />U 3a�—Doz <br />OwmNAWborl n Ign.lom Oe (Revia.d HN202„ <br />