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WATER 1 SEWER UTILIT�( APPLICATIUN CITY 4F EVERETT PERMIT SERVICES 3�d0 CEDAR STREET, EVERETf, WA 98201 (P) 425-257-8810 � FAX 425-257-8857 J�E) everetteps@everettwa.gov � www.everettwa.gov/permits UTILITY ARPLICATION IN�'ORMATION SEWER (check all that apply) WATER (check ali that apply) [s�SIDE SEWER REPAIR ❑ NEW WATER SERVICE INSTALLATION ❑ SIDE SEWER ALTERATfON ❑ COMPLETE SERV�CE � METER ONLY ❑ NEW SIDE SEWER INSTALI.ATION SERVICE t METER USE: ❑ lNSTALL BACKWATER VALVE (outside the building) � SFR ❑ SIqE SEWER GAP-OFF ❑ MULT!-FAMILY -# OF UN[TS: CI SiDE SEWER RECONNECTION ❑ COMMERGAL MULl'IPLE DOMESTIC WATER SERVICES REQUEST WATER SERViCE TYPE / SIZE: {circle desieed size) ❑ f AM QEGLINING MULTIPLE DOMESTIC WATER SERVICES F'OR ❑ DOMESTIC: 4 3/4", 1", 2", QTHER: MY MUGTI-FAMiLY DEVE�OPMENT UNDER SWGLE dWNERSHIP. ❑ �RRIGATlON; 3/4°, 1", 2", OTHER: � J AM OPTING TQ INSTALL MULTIPLE DOMESTIC WATER ❑ FIRE: 1", 2^, 4", 6", 8°, OTHER: SERVICES FOR MY MULTI-FAMILY DEVEIOPMENT UNDER ❑ DOMESTIC/FIRE COMBO: 1", 2", OTHER: SINGLE OWNERSHIP. FltL OUT REVERSE S/DE OF TN/S FORM. 14 Water and Sewer orsuch oiher rutes and regulations now existing or which may be establlshed from time to FEE � time. Tha applicanf furtheragrees, as a condition precedent to raceivrng service that the utrlities div/sion shaN have �� `�� the right at arry trme, wrthout notice, to shut o�f or turn an the waier supply fpr repairs, construction, and nonpayment of chargas or for any other reasonabte cause. I am the owner, o� I am authorized by the owner of this � propeRy to erform the work for whrch ptication is made, and t comply with the State Cvntractors Law 18.27 PERMIT # RC jnd 6.200A AC. � � � �� / O�Authorized Agent Fg�a r ,t j��Date�� n,� (R ised 10/12/2075) - ��: � �l `.