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� <br />,-..���� <br />(P) 425-257-8810 <br />WA,TER / SEWER I��ILITY A��LI�ATI�IV <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 INFORMA'i'ION <br />, <br />PROJECT ADDRESS: �j�,�� � <br />IF APPLICABLE: ❑ OUTSIDE CITY LIM1iS ❑ BUILDING AREA SF ❑ LOT # <br />BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑DULEX ❑MULTI-FAMILY-# OF UNITS: ❑COMMERCIAL ❑INDUSTRIAL <br />CHANGE OF USE? � N� ❑ 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 />�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 / SIZE: (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. ❑ IRRIGATION: 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 REVERSE SIDE OF THIS FORM. <br />AGREEMENT: Tl�e undersigned applrcant agrees to comply wrth all provisions of the Everett Municrpa! Code Title <br />14 Water and Sewer or such other rules and regulaiions now existing or which may be esta6lished from time fo <br />time. The applicant further agrees, as a condition precedent to recerving seivice that the utilities division shall have <br />the �rght at any time, without notrce, hut otf or turn on the water supply for repairs, construction, and <br />nonpa nt of charges or for a other r sonable cause. I am the owner, or / am autl�orized by the owner of this <br />pr erty to r e wo f r which ap icafion is made, and I comply with the State Contractors Law 18.27 <br />CW and 2 A WAC. �I �� J� ��/ <br />Owner/ th rize c7ent i_ na ure Date <br />0 <br />City of Everett Offrcial Use Only <br />FEE �, <br />��� <br />PERMIT # <br />U 2� � <br />(Revised i0/92/2015) <br />