2620 W MUKILTEO BLVD 2016-08-25 - Laserfiche WebLink

� �,__ �,�� `4��' ��T�R ��''�,a�l� U ��ll_fTY ��'! iC��!��f� C1TY 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 IJTILITY Ai'PLICATIORJ IWFORM/ATION SEWER (check all that apply) WATER (check all that apply) IDE 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 MULT(PLE DOMESTIC WATER SERVICES REQUEST WATER SERVICE TYPE / SIZE: (circle desired size) ❑ 1 AM DECLINING MULTIPLE DOMEST(C 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. F/LL OUT REVERSE SIDE OF THIS FORM. AGREEMENT.� The undersigned applicant agrees to comply with aU provisions of the Everefi Municipa! Code Title 14 Vl/ater and Sewer or such other n�les and regulations now existing or which may be established from time to time_ The applicant further agrees, as a condition precedent fo receiving service that fhe utilities division shall have the right at an time, withouf notice, to shut off or turn on the watersupply for repairs, construction, and nonpayme of r es or for any ofher reasonable cause. l am the owner, or l am aufhorized by the owner of this property t perfor e �t%¢rly�orlwhich application is made, and 1 comply with the State Contracfors Law 18.27 RCW and � a-�-�- � l� _ Agent Signafure 17ate City of Everett Utt�cial use uniy FEE � ��-�� PERMIT # � �� (Revised 10/12/2095)