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� <br />(P)425-257-8810 <br />ER 1 SEWER UTILITY �PLIGA71C7N <br />1�� <br />CITY' OF EVERETT PERMIT SERVICES <br />320t� CEDAR STREET, EVERETT, WA 982Q1 <br />FAX 425-257-88a7 � (E} everetteps@everettwa.gcsv � www.everettwa.govlpermits <br />UTILITY APPLICATIQN [NF4RMATItaN <br />SEWER {check all that apply} WATER (check all that apply) <br />Q SIQE SEWER REPAIR ❑ NEW WATER SERVICE INSTALLATI�N <br />❑ SIDE SEWER ALTERATION ❑ COMP�ETE SERVICE � METER ON�Y <br />❑ NEW SIDE SEWER INSTAILATION SERVICE! METER USE: <br />❑ INSTA�� BACKWATER VALVE (outside the buildingj ❑ SFR <br />❑ SiDE SEWER CAP-OFF ❑ MULTI-FAMILY -#� OF UNITS: <br />❑ SIDE SEWER RECONNEGTION ❑ GOMMERCIAL <br />MULTIPLE DOMESTIC WAfiEF2 SERVICES REQIIEST WRTER SERVICE TYPE'/ SIZE: (�ircie desired size} <br />� 1 AM DECLINING MULTIP�E DOMESTIC WATER SERVICES F�R � DOMESTIC: 3!4", 1", 2", OTHER: <br />MY MULTI-FAMILY DEVELOPMENT UNDER SINGLE OWNERSHIP. ❑(RRIGATION: 3/4". 1", 2". OTHER: <br />❑ t AM QPTING TO INSTALI lbiULi'IPLE DOMESTIC WATER ❑ FIRE: 1". 2", 4", 6", $", OTHER: <br />SERVICES FOR MY MULTI-FAMILY DEVEL�PMENT UNQER ❑ DOMESTIC/FIRE CQMBO: 1". 2", OTHER: <br />SINGLE OWNERSHtP. F1LL QtlT REVERSE SIDEOFTNIS FORM. <br />14 Water and Sawer oe ;uch oiher rules and regidations now existing or which may be establlshed trom [ime to <br />time. Lhe applicant further agrees. as a condltion /�recedenf to receiving se�vice that the uritiries divisron shall have <br />the right at any fime. ,vrthout nofice, to shut ofl or turn on the water• ser�p(y for repairs, construcfion. and <br />nonpaymerrt o( charges �r for any ather reasonab/e cause. f am the owner, or l am authodzed by the �wner o( th�s <br />property to perform Ihe work for which application is made. and 1 comply with the State Contractors law 18.27 <br />RCW �a 296.200A WAC. /% . ,I / <br />FEE ,. �- <br />�� � . � <br />PERMIT # <br />� r � ' '� �� <br />I i � 7 <br />_ ,/ i <br />(Revrsed 10tt2t2095) <br />����� <br />