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" WATER / SEWER UTtLITY APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />320fl CEQAR STREET, EVERETT, WA 98201 <br />(P) 425-257-881t7 � FAX 425-257-88b7 �(E) everetteps@everettwa.gov j www.everettwa.gov/permits <br />UTILITY APPLIGATION` 1N�ORMATION <br />SEWER (check all that appiy) WATER (check all that apply) <br />[�SIDE SEWER REPAIR ❑ NEW WAiER SERVICE INSTAL.LATION <br />❑ SIOE SEWER ALTEFtATION ❑ COMPLETE SERVIGE � METER ONLY <br />❑ NEW SIDE SEWER INSTALLATION SERVICE! METER USE: <br />� INSTALL BACKWATER VALVE {outside the building} ❑ S�R <br />❑ SIDE SEWER CAP-OFF ❑ MULTI-FAMILY -# OF UNITS: <br />❑ 51DE SEWER RECONNECT{ON � COMMERGIAL <br />MULTIPLE DOMESTIC WATER SERVICES REGIUEST WATER SERVICE TYPE i SIZE: (circle desired size} <br />❑ I AM DECUNING MUITiP�E DQMESTIC WATER SERVICES FOR ❑ DOMESTIC: 3/4", 1", 2", OTHER: <br />MY MULTI-FAMILY DEVELOPMENT UNDER SINGLE OWNERSHIP. ❑�RRIGATtON: 3/4", 1", 2", OTHER: <br />❑ I AM OPTING TO INSTALL MUITIPLE DQMESTIC WATER ❑ FIRE: 1", 2", 4", 6", 8", OTHER: <br />SERVICES FOR MY MU�TI-FAMILY DEVELOPMENT UNDER ❑ DQMESTIG/FIRE COM80: 1", 2", OTHER: <br />SINGLE OWNERSHIP. FILL OUT REVERSE SIDE OF TNlS FORM. <br />f4 Water and Sewer or such other rufes and regulations now existing or which may be establisheB from time to <br />time. The appHcant fu�ther agreas, as a condition precedeni to receiving service that the utilities drvislon shaU have <br />the rrght at any time, wi[hout nofice, to shut off or turn on the water supply for reparrs, constructron, and <br />nonp8yment of charges or for any other reasonable cause. 1 am the owner, or i am authorrzed by the ownar of this <br />property to pertorm the work for whrch application is made, and I comply with the State Corrtractors Law i8.27 <br />RCyYjs�d 296. 20p ^ WAC. `T r i t .� C.. ,, �' i"%� r ��� <br />/ r �/ <br />�� ( te � �����'..�'tf <br />FEE <br />. � `�-'' <br />PERMIT # <br />U fi�'��� � . _ �j� � <br />��e� 12/20i5) <br />