1805 RAINIER AVE A 2016-08-30 - Laserfiche WebLink

�� `f�� WATER / SEWER TIL�`�� PLICATiON 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 �� s�`: SEWER (check all that apply) ?JVATER (checl< all that apply) i ^. SiDE SEWER REPAIR ❑ NEW WATER SERVICE INSTALLATION ❑ SIDE SEWER ALTERATION ❑ COMPLETE SERVICE ❑ METER ONLY ❑ NEW SIDE SEWER INSTALLATION SERVIC� / METF_R USE: ❑ INSTALL BACKWATER 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 ❑ f=1RE: 1", 2", 4", 6", 8", OTHER: SERVICES FOR MY MULTI-FAMILY DEVELOPMEf�}T UNDER ❑ DOMESTIC/FIRE COMBO: 1", 2", OTHER: SINGLE OWNERSHIP. FILL DUT REVERSE SIDE OF THIS FORM. 14 Water and Sewer or sucli other rules and regulations now existing or which may be established frorn time lo time. The applicant further agrees, as a condition precedent to receiving service that fhe utilities division shall have the right 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. 1 am the owner, or 1 am aufhorized by the owner of this property to perform the work for which applicafio ' made, d I comply with tlie S�t�ntracfo s Law 1f3.27 RCW and 296.200A WAC. - ,!� � - '�y��;��.,%�1' ^ `� . �` j �- /.�., Owner/Authorized Agent Signature ` Date FEE � �� PERMIT # u ��r�� c�o 3 (Revised 10/12/2015)