5908 HIGHWAY PL 2016-08-26 - Laserfiche WebLink

��T�� S�W�R UT�L�TY ��P��A�� 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.gov/permits UTILITY APPLICATION INFORMATION SEWER (check all 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 SERVI�CE / METER USE: ❑ INSTALL BACKVI/ATER VALVE (outside the building) ❑ S�R ❑ SIDE SEWER CAP-OFF ❑ MULTI-FAMILY -# OF UNITS: ❑ SIDE SEWER RECONNECTION ❑ COMMERCIAL MULTIPLE DOMESTIC WATER SERVICES REQUEST WATER SERVICE TYPE / SIZE: (circle desired size) ❑ I AM DECLINING MULTIPLE DOMESTIC WATER SERVICES FOR ❑ DOMESTIC: 3/4", 1", 2", OTHER: MY MULTI-FAMILY DEVELOPMENT UNDER SINGLE OWNERSHIP. ❑ IRRIGATION: 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. F/LL OUT REVERSE SIDE OF THIS FORM. AGREEMENT: The undersigned applicant agrees fo comply v✓ith all provisions of the Everetf Municipal Code Title 14 Water and Sewer or such other rules and regulations now exrsting or which may be established from time to time. The applicani further agrees, as a condition precedent to receiving service that the ufilities division shall have the right at any time, witl�out notice, to shut off or turn on the water supply for repairs, consfruction, and nonpayment of charges or for any ofher reasonable cause. I am the owner, or I am authorized by the owner of this property to perform the work for which applicafion is made, and I comply with the State Contractors Law i8.27 RCW and�,96 200 � �AC�— — / J � � ��'% � �G Owner/Authorized Agent Signature Date City of Everett Official Use Only FEE Q 0 � ��,� � PERMIT # U l�� 'G� (Revised 10/12/2015)