3723 HOYT AVE 2017-01-13 - Laserfiche WebLink

(P) 425-257-8810 V�/AiER / SEWER IJiILIiY APPLIC�4ilON CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 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) �I'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. ❑ �RRIGATION: 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. 14 Water and Sewer or such other rules and regulations now existing or which may be established from time to fime. The applicant fu�ther agrees, as a condition precedent to receiving service that fhe utilities division shall have fhe �ight at an e, with notice, to shut off or turn on the water supply for repairs, construction, and nonpayme f ch es or fo ny other reasonable cause. I am the owner, or 1 am aufhorized by the owner of this prope�ty t rf he work fo hich application is made, and I comply y�ith the State Contractors Law 18.27 RCW an 6.2 WA �`'` �1.ii Owner/Autr��9nature FEE � �J PERMIT # u 0�� - (Revised 10/12/2015)