1110 ROCKEFELLER AVE 2017-01-23 - Laserfiche WebLink

UV� �R I ��1N�R �iIL,I�'Y' B �u PImICAi'IOIV CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 � FAX 425-257-8857 J(E) everetteps@everettwa.gov � www.everettwa.gov/permits 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 ❑ NEW SIDE SEWER INSTALLATION SERVICE / METER USE: �I 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 IYPE / SIZE: (circle 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 OWNERSHIP_ FILL OUT REVERSE SIDE OF THIS FORM, AGREEMENT: The undersigned applicant agrees to comply with al! provisions of the Everett Municipal Code Title 14 l�Uater and Sewer or such othe� rules and regulafions now exrsting or which may be established from time to time. The applicant further agrees, a con �" n precedeni to receiving service that the utilities division shall have the right at any ' e, w t notic , to shut off o turn on the wafer supply for repairs, const�uction, and nonpayment f ch r s or or an other reasona le cause. 1 am the owner, or 1 am authonzed by ihe owner of this property to p o� he wo hich applicatio is made, and I comply with fhe State �ontracto Is Law 18.27 RCW and 29 200 WAC � /1 , Sig�'ature Date Ciiy of Everett Otficial Use Only FEE � � �D, o, PERMIT# V L � l I � � (Revised 10/12/2015)