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. • ����� r ����� ��a�o�� ����ac������ <br />C1TY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 9820� <br />(P) 425-257-8810 � FAX 425-257-8857 �(E) everetteps@everettwa.gov � www.everettwa.gov/permits <br />PROJECT ADDRESS: <br />IF APPLICABLE: <br />BUILDING TYPE: <br />GE OF USE? <br />PROJEC7' SI7'E 9R�lFORt64id47'IOiV <br />�. _. 9 <br />� :� 1 � (.,� �-� , _ � l , �i' .. . t � <br />�� <br />❑ OUTSIDE CITY LIMITS <br />❑SFR-DETACHED ❑SFR-f <br />❑ NO ❑ YES, FROM <br />❑ BUILDING AREA SF ❑ LOT # <br />TTACHED ❑DULEX ❑MULTI-FAMILY�# OF UNITS: ❑COMMERCIAL ❑INDUSTRIAL <br />TO <br />l!7'ILITY APPLICATIOI� IIdFORMA'i'IOW <br />SEWER (check ali that apply) WATER (check all that apply) <br />�SIDE SEWER REPAIR ❑ NEW WATER SERVICE INSTALLATION <br />❑ SIDE SEWER ALTERATION ❑ COMPLETE SERVICE ❑ METER ONLY <br />❑ NEW SIDE SEWER INSTALLATION SERVICE / METER USE: <br />❑ INSTALL BACKVIIATER VALVE (outside the buiiding) ❑ SFR <br />❑ SIDE SEWER CAP-OFF ❑ MULTI-FAMILY-# OF UNITS: <br />❑ SIDE SEWER RECONNECTION ❑ COMMERCIAL <br />MULTIPLE DOMESTIC WATER SERVICES REQUEST WATER SERVICE TYPE / SIZE: (circle desired size) <br />❑ I AM DECLINING MULT[PLE DOMESTIC WATER SERVICES FOR ❑ DOMESTIC: 3/4", 1", 2", OTHER: <br />MY MULTI-FAMILY DEVELOPMENT UNDER SINGLE OWNERSHIP. ❑►RRIGATION: 3/4", 1", 2", O7HER: <br />❑ I AM OPTING TO INSTALL MULTIPLE DOMESTIC WATER ❑ FIRE: 1", 2", 4", 6", 8", OTHER: <br />SERVICES FOR MY MULTI-FAMILY DEVELOPMENT UNDER ❑ DOMESTIClFIRE COMBO: 1", 2", OTHER: <br />SINGLE OWNERSHIP. F/LL OUT REVERSE SIDE OF THIS FORM. <br />AGREEMENT.' The undersigned applicanf agrees to comply with all provisions of the Evereti Municipa! Code Title <br />94 Water and Sewer or such ofher rules and regulations now existing or whicl� may be esfablished from time to <br />time_ The applicant fu�fher agrees, as a condition precedenf fo receiving service thaf fhe utilifies division shall have <br />the right at any time, wifhout noiice, to shut off or tum on the wate� supply for repairs, construction, and <br />nonpayment of charges or for any other reasonable cause. l am the owner, or l am aufhorized by fhe owner of this <br />prope�ty to perfo�nr�fhe-lyork fof' whi� application is made, and I comply wi h the State Contracfors Law 18.27 <br />RCW and 29��CWAC. <br />l�r' . --'_'_----� F> (� �k' <br />Agent S <br />cuy or tverett vmaai use vruy <br />FEE � �� <br />� � _, <br />�� <br />PERMIT # <br />� ��,0�-� Q�� <br />(Revised 90/12/2015) <br />