6522 WETMORE AVE 2017-01-13 - Laserfiche WebLink

� � � W� ER / SEWER UTILITY A�PLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 � FAX 425-257-8857 �(E) everetteps@everettwa.gov � ww�v.everettwa.govipermits UTILITY APPLICATiON INFORMATION SEWER (check all that apply) WATER (check all that apply) SIDE SEWER REPAIR ❑ NEW WATER SERVICE INSTALLATION ❑ SIDE SEWER ALTERATION ❑ COMPLETE SERVICE ❑ METER ONLY L7 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 0 DOMESTIC: 3/4", 1", 2", OTHER: MY MULTI-FAMILY DEVELOPMENT UNDER SINGLE OWNERSHIP. O IRRIGATION: 3/4", 1", 2", OTHER: � i AM OPTING TQ INSTALL MULTIPLE DOMESTIC WATER ❑ FIRE: 1", 2", 4", 6", 8", OTHER: SERVICES FOR MY MULTI-FAMILY DEVELOPMENT UNDER ❑ DOMESTIC/F�RE COMBO: 1", 2", OTHER: SINGLE OWNERSHIP. FILL OUT REVERSE SIDE OF THIS FORM. 14 Water and Sewer or such other rules and reguiations now oxisting o� �vhich may be establisheo from time to time. The appficant furlher agrees, as a ccndifion precedent to �eceiving service that fhe ufilitres division shalf have the right at any time, without notice, to shut off or wrn on fhe watar supply for repairs, construr.tion, and nonpayment o(charyes or for any other reasonable �ause. 1 am the owner, or I am authorrzed by fhe owner o/ this property to perform the work i r which applicafion is made, and I comply with the State Contractors law 18, 27 R�Iv�a nd 29 �200A WAC. /' / {� ,� . . �i ., h .� , � _ G'i-, .� „ .� � r , _ � �, , i � rlAuthorize� Agqii� Signatur�� Date FEE ��06 _/ PERMIT # U ��'�3� (Revised �0/12/2015J