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+ . ���� / �� �� �J �'�I�Q`��' ��'��q�G��9�� <br />C1TY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 � FAX 425-257-88�7 �(E) everetteps@everettwa.gov � www.everettwa.gov/permits <br />- _ E INFORtVI.A7°'1�N <br />PRO.JEC'T' SI"� <br />PROJECT ADDRESS� ! G� i-{ ,3,� -t � —5 I <br />IF APPLICABLE: ❑ Ol1TSiDE CITY LIMITS ❑ BUILDING AREA SF ❑ LOT # <br />BUiLDING'TYPE: s�4SFR-DETACHED ❑SFR-ATTACHED ❑DULEX ❑MULTI-FAMILY-#OFUNITS: ❑COMMERCIAL ❑INDUSTRIAL <br />CHANGE OF USE? -�O ❑ YES, FROM TO <br />u-r�L��r�r �PPL�c�rio� ar�For�M�-roow <br />SEWER (check all that apply) WATER (check all that apply) <br />Y� SIDE SEWER REPAIR ❑ NEW WATER SERVICE INSTALLATION <br />❑ SIDE SEWER ALTERATION ❑ COMPLETE SERVICE ❑ METER ONLY <br />❑ NEW SIDE SEWER INSTALLATION SERVICE / NIETER USE: <br />❑ INSTALL BACKWATER VALVE (outside the building) ❑ SFR <br />❑ SIDE SEWER CAP-OFF ❑ MULTI-FAMILY-# OF UNITS: <br />❑ SIDE SEWER RECONNECTION ❑ COMMERCIAL <br />MULTIPLE DOMESTIC WATER SERVICES REQUEST WATER SERVICE TYPE / SIZE: (circle desired size) <br />❑ I AM DECLINING MULTIPLE DOMESTIC WATER SERVICES FOR ❑ DOMESTIC: 3/4", 1", 2", OTHER: <br />MY MULTI-FAMILY DEVELOPMENT UNDER SINGLE OWNERSHIP. ❑ IRRIGATION: 3/4", 1", 2", OTHER: <br />❑ I AM OPTING TO INSTALL MULTIPLE DOMESTIC WATER ❑ FIRE: 1", 2", 4", 6", 8", OTHER: <br />SERVICES FOR MY MULTI-FAMILY DEVELOPMENT UNDER ❑ DOMESTIC/FIRE COMBO: 1", 2", OTHER: <br />SINGLE OWNERSHIP. F/LL OUT REVERSE SIDE OF THIS FORM. <br />AGREEMENT.� The undersigned applicant agrees to comply with all provisions of the Everetf Municipal Code Title <br />94 lNater and Sewer or such ofher rules and regulations now existing or which may be established from time to <br />time_ The applicanf further agrees, as a condifion precedent fo receiving service that the utilities division shall have <br />the right at any time, witl�out notice, to shut otf or turn on the wafer supply for repairs, construction, and <br />nonpayment of charges or for any otherreasonable cause. I am the owner, or I am authorized by the owner of this <br />property to perform the work for which application is made, and I comply with the State Contractors Law 9827 <br />RCW and 296.200� WAC. <br />�G' � ! �/a�% � <br />Owner/A orized Aqent Sicjnature Date <br />City ot tverett uTrrc�ar use vnry <br />FEE <br />�� � , <br />PERMIT # <br />� � � � ���� <br />(Revised 10/92/2015) <br />