2610 CLEVELAND AVE 2017-01-13 - Laserfiche WebLink

WATER 1 SEWER UTILITY APPLICATIC}N GtTY OF EVERETT PERMIT SERVECES 32D0 CEDAFt STREET, EVERETT, WA 98201 (P) 425-257-8$10 � FAX 425-257-8857 ((Ej everetteps@everettwa.gov ( www.everettwa,gov/permits UTILITY APPLICATION MNFORMATIQN ' SEWER (check eil that apply) WATER (check all that apply) 0 SIdE SEWER REPAIR ❑ NEW WATER SERVICE INSTALLATION ❑ SIDE SEWER AITERATION ❑ COMPLETE SERVICE ❑ METER ONLY ❑ NEW SIDE SEWER INSTALLATION SERVICE I METER USE: ❑ 1NSTALL BACKWATER VALVE (outside the 6uilding} ❑ SFR O StDE SEWER CAP-UFF ❑ MULTI-FAMILY -# OF UNdT5: CI S1�E SEWER FtE�ONNECTION ❑ COMMERCIAL MU�TtPLE DOMESTIC WATER SERUICES REQIlEST WATER SERVIGE TYPE / SI2E: (circle desired size) ❑ I AM QECUNING MULTIPLE QOMESTIC WATER SERVICES FOR ❑ DOMESTiC. 3/4°, 1", 2", OTNER: MY MULTI-FAMII.Y DEVELOPMENT UNDER SINGLE OWNERSHIP. p �RRIGATION: 314", 1", 2", OTHER: ❑ I AM OPTING TO INSTALL MULTIPLE DOMESTIC WATER ❑ FIRE: T', 2", 4", 6", 8", OTHER: SERViCES FflR MY MULTI-FAMILY DEVELOPMENT UNDER ❑ ppMESTiC1FIRE COMBO: 1", 2", OTHER: SiNGLE OWNERSHiP. FILL OUT REVERSE SIDE OF TH/S FORM. AGREEMENT: The undarsigned applicant agrees to compty wrth all provisions pf ihe Everett Munrcipal Code Title 94 Wafer and Sewer or such other rules and regulations now existrng or wiiich may be este6lished fram tlme to time. The applrcant further agrees, as a conditian precedent to receJving servlce that the utilities dlvision shal! have ths right at any tima, without notrce, to shut off or turn o the water suppiy for repairs, consirucfion, and nonpaymeni of cha�ges or for any other reasonable cause. ! am the owner, or 1 am au[hoHzed by the ownsr ot this prope o perform the work for whrch appJicatJon ts made, and I comply wkh the State ContracYors Law i8.27 RCW and 286.200A WAC. � Crty of Everett Offidal Use Onty PER IT # rlene Lu d 11/14/2016 u��v ��"—" �� OwnerlAuthorized Agent Signature Date (Revlsed 9/23/2016)