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� <br />ER / SEWER UTILITY �PLICATION <br />VI�' <br />CITY OF EVERETT PERMIT SERVICES <br />32t1(i CEDAR STREET, EVERETT, WA 982Q1 <br />FAX 425-257-8$�7 �{Ej everetteps@euerettwa.gav � www.everettwa.gov/permits <br />. .. ... . .............. ..... . ...... .. . . ... _.. . . <br />UTIL.ITIf APPLICATIS?N IN�t?RMATION <br />SEWER (check all that apply) WATER (check all that apply) <br />Q SIDE SEWER REPAIR ❑ NEW WATER SERVICE INSTALLATION <br />❑ SIDE SEWER ALTERATION ❑ COMPLETE SERVICE � METER ONIY <br />❑ NEW SIDE SEWER INSTALLATION SERVICE ! METER USE: <br />❑ INSTALL BACKWATER VALVE (outside the building) ❑ SFR <br />❑ SIDE SEWER CAP-OFF ❑ MULTI-FAMIIY-#� QF UNITS: <br />❑ SIDE SEWER REGOf�INECTiON ❑ COMMERGIAL <br />MULTIPLE DOMESi1G WATER SERVICES REQUEST WATER SERVIGE T`YPE l SIZE: (cirole desired sizej <br />0 I AM DECUNING MULTlPLE DOMESTIC WATER SERUICES FQR � DOMESTIG: 3/4", 1"`, 2°, OTHER: <br />MY MULTI-FAMII.Y dEVELOPMENT UNDER SINGLE OWNERSHIP. ❑ �RRIGATI4N: 3/4", 1", 2". OTHER: <br />� 1 AM OPTING TO INSTALL MULTIPLE DOMESTIC WATER ❑ FIRE: 1", 2", 4", 6", 8", OTHER: <br />SERVICES FOR MY MULTI-FAMILY DEVELOPMENT UN�ER ❑ DOMESTICIFIRE COMBO: 1", 2", OTHER: <br />SINGLE OWNERSHIP, F1LL QtlT REYERSE SIDEOFTHiS FORM. <br />14 Water and Sawer or such other rules and regulatrons now existing or which may be establtshed (rom time to <br />!ime. ihe appl(cant further� agrees, as a condition precetlenf to receiving service ihat the utilities divrsion shali have <br />f1>e right at ��ny irme, r✓it�7out natice, to shut off or turn on the warer supnfy fo� repairs, construction. and <br />nonpaymen[ o/ charges or f�r any �ther reasonable cause. t am the awner, ur 1 am au�hanzed by the �wner ot this <br />propeRy to perfprm ihe work for which application is made. and 1 comply with the State Contractors Law 18.27 <br />RCW and 29fi.200A WAC. /% . ! / <br />Si�nature ( � / vare � �� � � �� <br />FEE �; � �. �_ <br />� . �-;� � : <br />�a � �, <br />PERMIT ,+ <br />U � . _ ? ,. '� <br />, �- ! -; <br />�- � <br />1 - <br />Revrsed 10;42�2015 <br />� ����� <br />