8301 XAVIER WAY 2016-08-31 - Laserfiche WebLink

j - _ �� - _ F�� - ;� i i `� ��4 -9- ; �. '��J ,�-, �.� 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 /�PPLICATIOW INFORMATIOW � 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 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: (circie 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. FILL OUT REVERSE SIDE OF THIS FORM. AGREEMENT.' The undersigned applicani agrees to comply with all provisions of the Everett Municipal Code Title 94 Vl/ater and Sewer or such other rules and regulations now existing or which may be established from time to time_ The applicant furfher agrees, as a condition precedent fo receiving service that the utilities division shall have the right at any time, without notice, to shut off or turn on the water supply for repairs, construciion, and ,....-.., . nonpayment of charges or for �� otherr��sonable cause. I am the owner, or / am authorized by the owner of th�s property to perform t%larndtfocwbiskr�applieefiiorr ismac-ia,--aad L c� ply with the Sfate Contractors Law 18.27 RCW and 296.200A WAC. �,,,.�.--------- Owner/Authorized Agent Signature Date s� City of Everefi Otficial Use Unly FEE � a �'�, r PERMIT # � ( (�'�� '�� ' a�� (Revised 90/92/2015)