2313 17TH ST 2017-01-13 - Laserfiche WebLink

4 �� I�► � - � W�R / SEWER UTILITY �PLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 � 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) �I SIDE SEWER REPAIR ❑ NEW WATER SERVICE INSTALLATION ❑ SIDE SEWER ALTERATION ❑ COMPLETE SERVICE ❑ METER ONLY ❑ 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: (circie 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 OW NERSHIP. FILL OUT REVERSE SIDE OF THIS FORM. AGREEMENT: The undersigned applicant agrees to comply with all provisions of the Everett Municipal Code Title 14 Water and Sewer or such other rules and regulations now existing or which may be established from time to time. The applicant (urther agrees, as a condition precedent to receiving service that the utilities division shall have the right at any- time, without notice, ro shut off or tum on the water supply for repairs, construction, and nonpayment of charges or for any ofher reasonab/e cause. I am the owner, or 1 am authorized by the owner of this property to perlorm the work for which application is made, and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. � �__..� Ciry of Everett Officia/ Use Only � PERM T # �- �--- U -r b Owner/Authorized Agen Date (Revised 923l2016)