238 HIGHLAND RD 2017-01-13 - Laserfiche WebLink

�.��, �� I�� 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 APPLICATIOPI 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: SWGLE OWNERSHIP. FILL OUT REVERSE SIDE OF TH/S FORM. 14 Water and Sewer or such other rules and regulations nov✓ existing or which may be esfablished from time to trme. Tl�e applicani further agrees, as a condition precedent fo receiving service that ihe utilities division shall have fhe right at any time, without noiice, to shut off or turn on the water supply for repairs, construcfion, and nonpayment of charges or for any other reasonable cause. I am the owner, or 1 am aufhorized by the owner of this property to perform the work for which applicatron is made, and 1 comply wifh the State Contractors Law 18.27 RCW 296 OOA WAC. / ��/ �—� C/_ �� /!G-� Agent Signature Date FEE � � 3a , PERMIT# � �� — (Revised 10/12/2015)