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����� / ����� ��I�'�� ����I���I�� <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 � FAX 425-257-8857 �(E) everetteps@everetiwa.gov � www.everettwa.gov/permits <br />UTILITY APPLICATIORJ INFORNiAT10N <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 />Q INSTALL BACKWATER VALVE (oufside 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 />, ,.., .�"..._,., . ..,� ....__. _.� __ _r� -- -� --- -- -- ,_ , _ , . <br />14 Water and Sewer or such ofher rules and regulations now existing or which may be established from time to <br />time. The applicant furtheragrees, a con �' precedent to receiving service thaf the utilities division shall have <br />the right at any � e, w' t notic , fo shuf off o turn on the water supply for repai�s, consfrucfion, and <br />nonpayment f ch r s or or an other reasona le cause. I am the owner, or 1 am authorized by the owner of this <br />prope�ty fo p for he wo hich applicatio is made, and I comply with the State Contractors Law 18.27 <br />RCW and 1_9 200 WAC / 1�1 1� I� T' I n <br />Y l A J <br />Date <br />FEE ^ <br />�iZ/ <br />PERMIT # <br />u `� Zr 6`� <br />(Revised 10/12/?_095) <br />