2305 RUCKER AVE 2017-01-13 - Laserfiche WebLink

WAiER / SEWER UTILITY AF'PLICi4T°ION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8F>10 � 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) � SIDE SEWER REPAIR ❑ NEW WATER SERVICE INSTALLATION ❑ SIDE SEWER ALTERATIOI� ❑ COMPLETE SERVICE ❑ METER ONLY ❑ NEW SIDE SEWER INSTA'_LATION �� J�� SERVICE / METER USE: ❑ INSTALL BACKWATER VALVE (outside the building) ❑ SFR ❑ SIDE SEWER CAP-OFF ❑ MULTI-FAMILY -# OF UNITS: ❑ SIDE SEWER RECONNEC;TION ❑ 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: SINGLE OWNERSHIP. FILL_ OUT REVERSE S1DE OF THIS FORM. AGREEMENT: The undersigned applicant agrees to comply with all provisions of the Everett Municipal Code Title 14 Wate� and Sewer or such other ruies and regulations now existing or which may be established from iime to time. The applicanf further agrees, as a condition precedent to receiving service that the utilities division shall have the right ai any time, without notice, tc� ut off or turn on the water supply for repairs, construction, and nonpayment of charges or for an th r easonable cause. 1 am the owner, or I am aufhorized by the owner of this property to perform the w for 'c � a plication is made, and I comply ith the Sfate Cont�actors Law 18.27 RCW and 296. WAC. �' r � Owner/Authorized Agent Signature Date City of Everett Otficial Use Only F E E �., �'j �(..�% � PERMIT # U � G�� 1 lj' �-� (Revised 10/12/2015)