1512 MCDOUGALL AVE 2016-08-12 - Laserfiche WebLink

�+ � I� �� . � �� '� -- �� "'�r� `� ` ��'� ��, ��w � �,�° � ` _ � CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 � FAX 425-257-8857 �(E) everetteps@everettwa.gov � www.everettwa.govlpermits UTILITY APPLICATIOW IIdFOFtM/ATIOW SEWER (check ali that apply) WATER (check all that apply) ❑ SIDE SEWER REPAIR ❑ NEW WATER SERVICE INSTALLATION ❑ SIDE SEWER ALTERATION ❑ COMPLETE SERVICE ❑ METER ONLY ❑ NEW SIDE SEWER INSTALLATION SERVICE / METER USE: � INSTALL BACKWATER VALVE (outside the building) ❑ SFR ❑ SIDE SEWER CAP-OFF ❑ MULTI-FAMILY -# OF UNITS: ❑ SIDE SEWER RECONNECTION ❑ COMMERCIAL MULTIPLE DOMESTIC WATER SERVICES REQUEST WATER SERVICE TYPE / SIZE: (circie desired size) ❑ 1 AM DECLINING MULTIPLE DOMESTIC WATER SERVICES FOR ❑ DOMESTIC: 3/4", 1", 2", OTHER: MY MULTI-FAMILY DEVELOPMENT UNDER SINGLE OWNERSHIP. ❑ �RRIGATION: 3/4", 1", 2", OTHER: ❑ I AM OPTING TO INSTALL MULTIPLE DOMESTIC WATER ❑ FIRE: 1", 2", 4", 6", 8", OTHER: SERVICES FOR MY MULTI-FAMILY DEVELOPMENT UNDER ❑ DOMESTIC/FIRE COMBO: 1", 2", OTHER: SINGLE OWNERSHIP. FILL OUT REVERSE SIDE OF TH/S FORM. AGREEMENT.' The undersigned applicant agrees to comply with all provisions of the Evereft Municipal Code Title 94 Water and Sewe� or such other rules and regulations now exisfing or which may be esfablished from fime to time. The app/icanf further agrees, as a condition precedenf to receiving service that the utilities division shall have the �ight at any time, without notice, to shut off or turn on the water supply for repairs, construction, and nonpayment of charges or for any other reasonable cause. I am fhe owner, or l am authorized by the owner of this property to perform the work for which application is made, and I comply with fhe State Contracto�s Law 18.27 RCW and 296.200A WAC. � ��%�'�-----" j - - �_ �-- — �' � Agent Signature Date City of Everetf Offrcial Use Only FEE ' � � �� i PERMIT # � I ��' �,-�z (Revised 90/92/2015)