1123 RUCKER AVE 2017-01-13 - Laserfiche WebLink

WATER ! SEWER UTILITY APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 982Q1 {P� 425-25�-8810 � FAX 425-257-8857 �(E} everetteps a�everettwa,gov j www.everettwa,gov/permit5 UTILITY APPLICATION"INFfJRMATI�N , BEWER (check all that apply) WATER (check ail that apply) 0 SIDE SEWER REPAIR ❑ NEW WATER SERVICE INSTALLATION ❑ SIDE SEWER AITERATIQN ❑ GOMPLETE SERVICE ❑ METER ONLY L7 NEW SIDE SEWER INSTALLRTION SERVICE ! METER USE: ❑ INSTALL BACKWATER VAIVE (outside the building) ❑ SFR ❑ SIDE SEWER CAP-OFF � MULTI-FAMILY -# dF UNITS: O SIDE SEWER RECONNECTION � COMMERCIAL MULTIPLE DOMESTIC WATER SERVICES REQUEST WATER SERVICE TYPE ! S1ZE: (cirole desired size) ❑ I Afvl DECL(NING MULTIPLE DOMEST(C WATER SERVICES FOR ❑ DOMESTIC: 3(4", i", 2", OTHER: MY MULTI-FAMILY DEVELOPMENT UNDER SINGLE OWNERSHIP. ❑ �RRIGATION: 3/4", 1", 2", OTHER: 0 I AM OPTING TO INSTALL MULTIPLE DOMESTIC WATER ❑ FIRE: 1", 2", 4", 6", 8", OTHER: SERVICES FOR MY MULTI-FAMILY OEVEL�PMENT UNDER ❑ DOMESTIClFIRE CQMBO: 1", 2", OTHER: SINGLE OW NERSH�P. FILL OUT REVERSE SIDE OF THIS FpRM. AGREEMENT.' The underslgned appllcant agrees to compty wrth al! provisions of the Everett Munrcrpal Cade Title T 4 Water and Sewer or such otlter rules and regWatlons now existing or whrch may be estabiished from tfine to lime, The applrcant further agrees, as a condition ptecedenf to receiving service that tha utilities division shall have the right at any time, without notice, to shut off or turn on the weter suppfy for repairs, construction, and nonpayment of charges or for any other reasonable cause. I am the owner, or I am euthl� jz d the owner of this property to perl the wo�ic lor whlch appUcatton ts made, e�d t compry wttn tne steie conrracrors tew �o.zt rtcw ana zgti.�uun wno. City of Everett O�cial Use Only � v PER IT # � arlene Lundgr � 11 /11 /2016 U� ~ O` OwnerlAuthorized Agent Slgn re Date (Revised 9/23I2016)