Laserfiche WebLink
' WATER / SEWER UTILtTY APPLIGATIC3M <br />� C(Tl' OF EV�RETT� PERMIT ��ER�IICES <br />� 3204 CEDAR STREET, EVERETT, WA 98241 <br />(P) 425-257-8810 � FAX 425-25i-8857 j{E} ever�tteps@everettwa.gc�v � www.everettwa.govlpermits <br />� � � UTILITY� ��`PLiCAT�It'�1�1 I��NFClRIi�tIAT10N <br />SEWER (check all that apply) WATER (check ail thaf apply) <br />StDE SEWER REPAIR ❑ NEW WATER SERViCE INSTALLATION <br />C� SIDE SEWER ALTERATION ❑ COMP�ETE SERVICE ❑ METER pNLY <br />0 NEW SIDE SEWER ItJSTALLATItJN SE�VIGE! METER USE: <br />� INS7ALL BACKWATER VALVE (outside the buiiding} � 5FR <br />❑ SIDE SEWER CAP-OFF ❑ MULTI-FAMILY -# UF UNf7S; <br />O SIpE SEWER RECONNECTiON L� GOMMERGEAL <br />MULTIPLE [301UIEST(C 11UATER SERVICES REQUES'1' WATER SE�'tVICE TYRE I SIZE: (circ{e desired sizej <br />O I AM dECUNING MULTIPLE QOMESTIC WATER SERVICES FQR ' C) DOMESTIG: 3t4", 1", 2", OTHER: <br />MY MULTI-FAMILY QEVELt}PMENT UNDER StNGLE (3W NERSHIP. ❑ �RRIGATION: 3i4", 1", 2", �THEft: <br />❑ I AM OPTING TQ INSTALL MULTIPLE DOMESTIC WATER ❑ FIRE: T'. 2", 4", 6", $", OTHER: <br />SERVICES FUR MY MULTf-FAMILY DEVELUPMENT UNDER ❑ pp���T1C/FIRE COMBO: 1", 2", OTNER: <br />SINGLE OV�/NERSHIP. �ILL OUT REVERSE St�� GF TH1S FORM. <br />1�t Water and Sewar vr suc1� aU�er niles and regulations now axisting or which rnay be esteblished from time to <br />fime. The applicanl huiher agrees. as a condition precedent io receiving se+vice that tfte utilities div�sion shal! have <br />the rryht at eny time. r✓iihouf notice, to stiu[ off or tum on the water supply fnr repalrs. canstruciion, and <br />nonpayment of charges or for any other reasonable cause. ! ar the owner, or ! am authorized by t1�e owner of lhis <br />property to pe�lonn the work f which application is made, and t cornply wrth the Siate Contraciors Law 18.27 <br />W d 296.2 A WAC. <br />.5�� l <br />erJAutho�ized A n �gnature Date <br />FEE � <br />���A� <br />PERMIT � <br />v -�2 <br />(Revised 10/12/2095) <br />