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WATER / SEWER UTILITY APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />EVERETT SUBMITTAL INSTRUCTIONS: Dmp of hand copy paper application B plans 1a 32M Clear Street 2nd Floor Intake Drop Box. <br />WASHINavoll CONTACT INFORMATION: (P)4M.25].88101(E)PormllSarvlmaWeverMlwaOw I(W)everelMs.Oovlpermite <br />PROJECT SITE INFORMATION <br />PRWECTADDRESS: IIIIL IIAWC S�I <br />IFAPPLICABLE: ❑ OUTSIDE CITY LIMITS ❑BUILDING AREA SF ❑LOTS <br />BUILDING TYPE: OSFR OTOWNHOUSE ODUPLEX DADU DMULTFFAMILY40FUNRS: OCOMMERCIAL DACCESSORY <br />CHANGE OF USE? ❑ NO LIVES, FROM TO <br />UTILITY APPLICATION INFORMATION <br />SEWER(check all that apply) <br />WATER pcheck all that apply) <br />❑ SIDE SEWER REPAIR <br />0 SIDE SEWER ALTERATION <br />❑ NEW SIDE SEWER INSTALLATION <br />❑ INSTALL BACKWATER VALVE practice the buNEbyU <br />❑ 310E SEWER CAP -OFF <br />❑ SIDE SEWER RECONNECTION <br />D BACKFLOW PREVENTION (Outske) -Specify dev/ce type below: <br />13RPB4(Gom.) DDCVA(aom.) DDCVA(Irr.) ODCDAUre) <br />D WATER LINE BEHIND METER (maser afterallon) <br />D NEW WATER SERVICE INSTALLATION <br />Specify Installation We below: <br />❑ NEW COMPLETE SERVICE <br />❑METER ONLY <br />Specify wehrsevlaa type& size below: <br />❑DOMESTIC: IJIVO 01" 712' DOlher: <br />IRRIGATION: 0WF 01" 02' 00ther: <br />❑FIRE: Ml. 02" 04' 08" 05" DOIM1en <br />❑DOMESTICIFIRECOMND' 01" 02' 001her: <br />MULTIPLE DOMESTIC WATER SERVICES REQUEST <br />❑ I AM DECLINING MULTIKE 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. PILL OUTREVERSE SIDEOF THIS FORM. <br />CONTACT INFORMATION <br />OWNERNAME: <br />I <br />y TENANT BUSINESS NAME(I1 ConamemlaB: <br />//����//���pp <br />OWNER MAILING ADDRESS: 3Ci/I - /VAF&k <br />Sly <br />(AN frooll ZIP <br />OWNERPHONE: <br />31-115"q <br />IOWNEREMAIL, jQj,C, 60Ti(l <br />([< <br />CONTRACTOR NAME: O <br />CONTRACTORADDRESS: smear <br />CRY mca6 ZIP <br />CONTRACTOR PHONE: <br />CONTRACTOREMAIL: <br />CONTRACTOR LIC. N(REOUIRED): CITY OF EVERETT BUSINESS LIQ R(REpUIREO)y <br />PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ❑ OTHER(Please Specly) <br />CONTACTNAME: <br />CONTACT PHONE: <br />CONTACT EMAIL: <br />AGREEMENP. bcampa M1 eppulNeneWlhe Ewntt MUMYpsICwb Ink 14 Nble/eMSexW olsurM1aMNrvk+entlrepubabna rcw <br />eMMpdwNM mry6ee51edYeM1etl/mm1Ame Acres, IlieelVK'enlfwlM1wagma; ese[mdLbn p'ttMenlbrtmhAweervltt IMIIMUMXYks oMSbaeMM lace corner <br />sm@re.wer"nMk0. to NwfsrtwWlnmlM wder+upply Rv repah, Ammer an.I am IM s+mw. wlam <br />au1M1a'trN by has Pa cork lw aPkl applk&bn IS cases, aol l carro MM IM Slsie Cmlmabrs Lax l&P)RCWaM w2WA WAC <br />WPrertll Gflkkl Use On <br />PERMTpI <br />/[ cl Zlhoy U ti301 — 037 <br />Owdedou BwrIzeBTgemstanawre Cate posmaldivelezl) <br />