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(P) 425-257-8810 � <br />W�iER / SEWER I��ILITY A�PLI�,AT'IOiV <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />FAX 425-257-8857 �(E) everetteps@everettwa.gov � www.everettwa.gov/permits <br />PROJECT SITE INFORMATION <br />PROJECT ADDRESS: � ., �,�""'sj�'� <br />IF APPLICABLE: ❑ OUTSIDE CITY LIM«S ❑ BUILDING AREA SF ❑ LOT # <br />BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑DULEX ❑MULTI-FAMILY-# OF UNITS: ❑COMMERCIAL ❑INDUSTRIAL <br />CHANGE OF USE? ❑ NO ❑ YES, FROM TO <br />UTILITY APPLICATION INFORMATION <br />SEWER (check all that apply) WATER (check all that apply) <br />❑ SIDE SEWER REPAIR ❑ NEW WATER SERVICE INSTALLATION <br />❑ SIDE SEWER ALTERATION ❑ COMPLETE SERVICE ❑ METER ONLY <br />❑ NEW SIDE SEWER INSTALLATION SERVICE / METER USE: ` <br />I�INSTALL BACKWATER VALVE outside the building) ❑ SFR <br />❑ SIDE SEWER CAP-OFF ❑ MULTI-FAMILY -# OF UNITS: <br />❑ SIDE SEWER RECONNECTION ❑ COMMERCIAL <br />MULTIPLE DOMESTIC WATER SERVICES REQUEST WATER SERVICE TYPE / S[ZE: (circle desired size) <br />❑ I AM DECLINING MULTIPLE DOMESTIC WATER SERVICES FOR ❑ DOMESTIC: 3/4", 1", 2", OTHER: <br />MY MULTI-FAMILY DEVELOPMENT UNDER SINGLE OWNERSHIP. ❑ �RRIGATION: 3/4", 1", 2", OTHER: <br />❑ I AM OPTING TO INSTALL MULTIPLE DOMESTIC WATER ❑ FIRE: 1", 2", 4", 6", 8", OTHER: <br />SERVICES FOR MY MULTI-FAMILY DEVELOPMENT UNDER ❑ DOMESTIC/FIRE COMBO: 1", 2", OTHER: <br />SINGLE OWNERSHIP. F/LL OUT RE'VERSE S/DE OF THIS FORM. <br />AGREEMENT. The undersigned applicant agrees to comply with al! provisions of the Everett Municipal Code Title <br />14 Water and Sewer or such other rules and regulations now existing or which may 6e established from time fo <br />time. The applicant further agrees, as a condition precedent to receiving service that the utilities division shall have <br />the rrght af ' e, 'thout notice, to shut off or turn on the water supply for repairs, construction, and <br />nonpa ent of c r e or for an othe�r onab cause. I am the owner, or 1 am authorized by the owner of this <br />pro rty to perfo e or or w! "c pplication is made, and l comply with the State Contractors Law 18.27 <br />W and 296.2 OA A. _ <br />OwnerlAuth <br />L/ <br />Date <br />Cify of Evereti Offrcial Use Only <br />FEE <br />�� <br />PERMIT # <br />U � J !� � � r� L�� <br />(Revrsed 10/12/2015) <br />