2017 53RD ST SE 2017-01-13 - Laserfiche WebLink

WATER / SEWER UTILITY APPLICATIC�N CITY OF EVERETT PERMIT SERVICES 3200 GEDAR STREET, EVERETT, VtiIA 9�201 (P) �25-257-8$10 � FAX 425-257-8857 ({E) everetteps@everettwa.gov � www.evere#twa.govlpermits UTILITY APPLICATION iNFORMATION ' SEWER (check ail 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 SERVECE ! METER USE: ❑ INSTALL BACKWATER VALVE (outside the buiiding} � SFR ❑ SIDE SEWER CAP-OFF ❑ MULTI-FAMILY -# OF UNITS: ❑ SIDE SEWER RECONNECTIQN ❑ COMMERCIAL MULTIPLE DOMEBTIC WATER SERVICES REQUEST WATER SERVIGE TYPE / SIZE: {circEe desired size) �( AM QECUNlNG MULTIPLE DOMESTIC WRTER BERVICES F'UR ❑ DpMESTtC: 3/4", 1", 2", OTHER; MY MULTI-FAMILY OEVE�OPMENT UNDER SINGLE QWNERSHIP. ❑ ��RIGATION: 3!4", 1", 2", OTHER: ❑ i AM OPTING i0 INSTALL MULTIPtE DOMEBTIC WATER ❑ F(RE: 1", 2", 4", 6", S", OTHEf�: SERVICES FOR MY MULTI-FAMILY DEVELOPMENT UNDER ❑ DOMESTIClFIRE COMBO: 1", 2", OTHER: SINGLE OWNERSHIP. FlLL OUT REVERSE SIDE OP THIS FORM. 14 Watar and Sawer or such other rufes and regufatioos now existing or which may tre estabiished itam tfine to tlma. Fhe applicant further agrees, as a condition precedent to rece(v(ng service that the uliilties divlsion shali have the rtght at any tfine, wfthout raotice, to shut o�f or furn on fhe water suppty for repairs, constzetion, and nonpayment of charges or ior any other reasonabie cause. J am the owner, or 1 am authorized by the owner ol this propedy to perform the work for hiCh aAp��CaPion is made, and I comply with the State Contractors Law 18.27 R��d 236.2QOA WAC. � � _�` ; ,� � �°� � �--..1� h � � �� 1 � � � � Date FEE � � Q � i� � �� PERM IT # U j �� - ��.�`1 (Revised 90li212075)