931 MAPLE ST 2016-08-24 - Laserfiche WebLink

��, / � � � �� �� I�� I��'�� CITY OF EVERETT PERMIT SE VICES 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 � FAX 425-257-8857 �(E) everetteps@everettwa.gov � www.everettwa.gov/permits UTILITY APPLICATIOW INFORM�ITIOW SEWER (check ali that apply) WATER (check all that apply) f�..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: (circle desired size) ❑ I 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 THIS FORM. HC�KttMtlVl: Ine unoers�yneo appucarn dyrees iv cuiuNry w�u� au µ�� , ��,� ��,�.� �.,�,,,�,N�, .,..�.. ,,.,.. 14 Water and Sewer or such other rules and regulations now existing or which may be established from time to time. The applicant further agrees, as a condition precedent to receiving service that the utilities division shall have the �ight at any time, withouf noiice, to shut off or turn on the water supply for reparrs, constn�cfron, and nonpayment of charges or for any other reasonable cause. ! am the owner, or I am authorized by ihe owner of this properfy to perform the work for which appU ation is ma e, and I comply with the Sfate Contractors Law i827 RCW and.�6.200A WAC. /1 �� /� n�� +�fi � .. .� .,, � ........ .....�._. ___ _ FEE \ �� V �j PERMIT # � � � � (Revised 90/12/2015)