7021 BERKSHIRE DR 2017-01-13 - Laserfiche WebLink

W�� I�� i��..��AT�� 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) 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: 1", 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 applicant agrees to comply with all provisrons of the Everett Munrcipal Code Title 14 Water and Sewer or such other rules and �egulations now existing or which may be established from time to time. The applicant further agrees, as a condition precedenf to receiving service that the utilities division shall have the right at any time, without notice, to shut off or ium on the water supply for repairs, construction, and nonpayment of charges or for any other reasonable cause. 1 am the owner, or 1 am authorized by the owner of this property to perfor the work for which application is made, and 1 comply with the State Contractors Law 18.27 RCW and 296.2� �. � � � .�--�-�, ► ��z� � T ner/Authorized Agent Signat r Date City of Everett Otficial Use On/y FEE � � � d �J PERMIT # u� ��2— oz3 (Revised 10/12/2015)