2107 ADAMS AVE 2017-01-13 - Laserfiche WebLink

� � � WATER / SEWER UTILITY APPLICATION 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 APPLICATION INFORMATION SEWER (check all that apply) WATER (check all that apply) 0 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: (circle 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: t", 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 appficant agrees to comply with all provisions o! the Eveiett Municipal Code TiUe 14 Water and Sewer or such other rules and regulations now existing o� which may be established from time to time. The applicant further agrees, as a condition precedent to receiving service that the utilities division shall have the riqht at any time, without notice. to shut oN o� tum on the ter suppty for repairs, Construction, and nonpayment ol cha�ges or /or any other reasonable cause. I am the owner, or 1 am authonzed by the ovmer ol this property to rm the work for which application is made. and I compty v�rth fhe Sfate Contracfors Law 18.27 RCW and 29G.200A WAC. Cily of Everett OKcial Use Onfy � � c� uM� # t —020 Owne Authorized Agen Signatu Date (Revised 9/23�2016)